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Radiographic identification of thoracoabdominal hernias

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Abstract

Purpose

Hernias spanning both chest and abdominal walls are uncommon and associated with chest wall trauma, coughing and obesity. This study describes the radiographic appearance of these hernias to guide proper identification and operative planning. Proposed standardized reporting patterns are also presented.

Methods

The cross sectional imaging of patients presenting with thoracoabdominal hernias was reviewed. Radiographic reports were supplemented by surgeon imaging review and operative findings during repair. Defect dimensions, hernia content, level of herniation, presence of osseous or cartilaginous disruption of the chest wall and degree of rib displacement were collected. Disruption of myofascial planes was also noted.

Results

Six patients were identified. All hernias occurred below the 9th rib and were associated with complete intercostal muscle disruption. The transversus abdominis was disrupted in all hernias and the internal oblique was disrupted in five of the hernias. The majority (83%) had caudal rib displacement (median 6.8 cm compared to contralateral side). Median hernia width was 10.35 cm (1.6–19.1 cm) and median length was 10.2 cm (1.8–14.3 cm). Five patients had associated bone/cartilage injuries: two with 11th rib fractures, two with combined bone and cartilaginous fractures and one with a surgical rib resection.

Conclusion

The typical injury pattern of thoracoabdominal hernias includes disruption of the intercostal muscles, transversus abdominis, and commonly the internal oblique with an intact external oblique. Inferior rib displacement by hernia contents and unopposed pull of the abdominal musculature is common. Osseous or cartilaginous disruption always occurs unless the defect is bounded on at least one side by a floating rib.

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Acknowledgements

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Funding

No internal or external financial support was used for this report.

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Authors and Affiliations

  1. Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, H149, Hershey, PA, 17033-0850, USA

    David J. Morrell, Colin G. DeLong, Charlotte M. Horne & Eric M. Pauli

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  1. David J. Morrell
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  2. Colin G. DeLong
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  3. Charlotte M. Horne
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  4. Eric M. Pauli
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Corresponding author

Correspondence to Eric M. Pauli.

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Conflicts of interest

Eric Pauli reports teaching honoraria, research support, and Data and Safety Monitoring Board membership for Beckton, Dickinson and Company (BD), teaching honoraria and consultant fees from Boston Scientific Corp., teaching honoraria from Cook Biotech, Inc., consulting fees and research support from Actuated Medical, Inc., royalties from Springer, royalties from UpToDate, Inc., consulting fees from Wells Fargo and Company, consulting fees from CMS Robotics, teaching honoraria from Medtronic, PLC, and consulting fees from Baxter International, Inc. unrelated to this report. Charlotte Horne reports teaching honoraria for Medtronic, PLC unrelated to this report. The remaining authors have no conflicts of interest.

Ethical approval

Following approval by the Penn State Health institutional review board, a prospectively maintained, quality improvement database (Abdominal Core Health Quality Collaborative) of patients who had undergone ventral hernia repair performed by a single abdominal wall reconstructive surgeon was queried to identify all patients that had presented for repair of thoracoabdominal hernias between August 2013 and September 2019.

Informed consent

Due to the retrospective nature of this study, informed consent was waived by the institutional review board.

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Morrell, D.J., DeLong, C.G., Horne, C.M. et al. Radiographic identification of thoracoabdominal hernias. Hernia 26, 287–295 (2022). https://doi.org/10.1007/s10029-021-02437-1

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  • DOI: https://doi.org/10.1007/s10029-021-02437-1

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