title: Embryogenesis and types of subcostal hernia--a rare entity.
abstract: OBJECTIVE
  Four infants with congenital subcostal hernia are reported, as it is a rare entity with only two cases previously reported. Further, there are no reports concerning the complex multisystem subtype. Embryogenesis of the associated anomalies and subcostal hernia and their management are discussed.
  
  
  METHODS
  Clinical features, history, investigations, associated anomalies, and management data of four patients with subcostal hernia were collected and analyzed.
  
  
  RESULTS
  The following associated anomalies were detected: renal agenesis (2), musculoskeletal abnormality (3), congenital heart disease (2), müllerian-renal-cervicothoracic somite abnormalities and vertebral-anorectal-cardiac-tracheoesophageal-renal-radial-limb anomalies (1). The subcostal hernias were treated by laparoscopic assisted (3) or laparoscopic herniorrhaphy (1).
  
  
  CONCLUSIONS
  Subcostal hernia is a rare entity with varied clinical presentations and presents either as an isolated defect or as a complex multisystem defect. The exact etiology is still unknown. Phenotypic manifestation of the complex defect is probably due to developmental gene defect affecting the coordinated growth of mesoderm around 4th to 10th weeks of fetal life.
authors.affiliation: Department of Pediatric Surgery, VaniVilas Hospital, Bangalore Medical College & Research Institute, Bangalore 560002, India. drsrraghu@gmail.com
authors.forename: S R
authors.initials: SR
authors.lastname: Raghu
authors.forename: Anand
authors.initials: A
authors.lastname: Alladi
authors.forename: Deepti
authors.initials: D
authors.lastname: Vepakomma
authors.forename: O S
authors.initials: OS
authors.lastname: Siddappa
authors.forename: Preetha
authors.initials: P
authors.lastname: Tilak
mesh_terms: D005260:Female; D006547:Hernia / Q000145:classification / Q000151:congenital* / Q000196:embryology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012272:Ribs; D035441:Thoracic Wall