title: Strangulation of chronic transdiaphragmatic intercostal hernia.
abstract: Transdiaphragmatic intercostal hernia (TIH) caused by violent coughing is a rare clinical diagnosis. Most patients diagnosed with TIH have a chronic condition consisting of a hernia that can be reduced completely by surgical intervention. Our patient presented with acute abdomen resulting from mechanical bowel obstruction secondary to an incarcerated hernia. Acute TIH presents a diagnostic challenge because of its rarity and lack of specific signs or symptoms in the differential diagnosis of acute abdomen. We recommend performing diagnostic computed tomography (CT) early if there is suspicion of TIH. Surgical intervention is always needed. Surgical intervention was complicated in this case, necessitating both transthoracic and abdominal exposure to resect the ischemic bowel segment. Nonetheless, the patient recovered uneventfully.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Peiyu
authors.initials: P
authors.lastname: Kao
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Hsin-Yuan
authors.initials: HY
authors.lastname: Fang
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Ting-Yu
authors.initials: TY
authors.lastname: Lu
authors.affiliation: Division of General Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Shih-Chao
authors.initials: SC
authors.lastname: Hsu
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chien-Kuang
authors.initials: CK
authors.lastname: Chen
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan. Electronic address: prchencs@gmail.com.
authors.forename: Pin-Ru
authors.initials: PR
authors.lastname: Chen
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003371:Cough / Q000150:complications*; D005598:Fractures, Spontaneous / Q000150:complications*; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D012253:Rib Fractures / Q000150:complications*; D014057:Tomography, X-Ray Computed