title: Symptomatic intercostal lung hernia secondary to sternal dehiscence surgery.
abstract: Patient: Male, 60Final Diagnosis: Iatrogenic intercostal lung herniaSymptoms: -Medication: No medicationClinical Procedure: Surgically cerrectedSpecialty: Thoracic surgery.
  
  
  OBJECTIVE
  Unusual clinical course.
  
  
  BACKGROUND
  Iatrogenic intercostal lung hernia is a rare thoracic pathology. Injury of intercostal muscles and costocondral separation during median sternotomy and sternal dehiscence surgery are important factors in the development of hernia. We report for the first time a case of a 60-year-old man with acquired lung hernia after sternal dehiscence surgery, presenting as chest pain and exertional dyspnea.
  
  
  METHODS
  A 60-year-old man presented with a 6-week history of progressive exertional dyspnea, particularly following vigorous coughing. Past medical history included slight chronic obstructive pulmonary disease and coronary artery bypass grafting surgery 8 weeks previously, using the left internal mammary artery for the left anterior descending artery via median sternotomy and sternal dehiscence by the Robicsek method. A chest X-ray showed intact sternal and parasternal wires, but the bilateral lung parenchyma appeared normal. A spiral computed tomography scan of the chest found intercostal herniation of the anterior segment of the left upper lobe. The lung hernia was repaired surgically to relieve exertional dyspnea and incarceration, and to improve respiratory function. The postoperative course was uneventful and the patient recovered well.
  
  
  CONCLUSIONS
  Intercostal lung hernia after median sternotomy and sternal dehiscence surgery is rare, and it has been previously reported on. Preventive techniques include gentle manipulation of the sternal retractor, avoidance of rib fractures, and using a protective method of intercostal arteries and nerves such as Sharma technique. Thoracic surgeons should be aware of this rare complication in sternal dehiscence surgery.
authors.affiliation: Department of Thoracic Surgery, Medicana Hospitals Çamlıca, Istanbul, Turkey.
authors.forename: Sezai
authors.initials: S
authors.lastname: Celik
authors.forename: Cüneyt
authors.initials: C
authors.lastname: Aydemir
authors.forename: Onur
authors.initials: O
authors.lastname: Gürer
authors.forename: Omer
authors.initials: O
authors.lastname: Işık
keywords: anterior; hernia; iatrogenic; intercostal; lung; postoperative