title: Rare case of a strangulated intercostal flank hernia following open nephrectomy: A case report and review of literature.
abstract: BACKGROUND
  Flank incisions may be associated with incisional flank hernias, which may progress to incarceration and strangulation. Compromised integrity of the abdominal and intercostal musculature due to previous surgery may be associated with herniation of abdominal contents into the intercostal space. There have been six previously reported cases of herniation into the intercostal space after a flank incision for a surgical procedure. This case highlights the clinical picture associated with an emergent strangulated hernia and highlights the critical steps in its management.
  
  
  METHODS
  We present a case of a 79-year-old adult man with multiple comorbidities presenting with a strangulated flank hernia secondary to an intercostal incision for a right-sided open nephrectomy. The strangulated hernia required emergent intervention including right-sided hemi-colectomy with ileostomy and mucous fistula.
  
  
  CONCLUSIONS
  Abdominal incisional hernias are rare and therefore easily overlooked, but may result in significant morbidity or even death in the patient.. The diagnosis can be made with a thorough clinical examination and ultrasound or computed topographical investigation. Once a hernia has become incarcerated, emergent surgical management is necessary to avoid strangulation and small bowel obstruction.
  
  
  CONCLUSIONS
  Urgent diagnosis and treatment of this extremely rare hernia is paramount especially in the setting of strangulation.
authors.affiliation: Morehouse School of Medicine, Department of Surgery, 720 Westview Drive SW, Atlanta, GA 30310-1495, United States.
authors.forename: Oluwaseun O
authors.initials: OO
authors.lastname: Akinduro
authors.affiliation: Morehouse School of Medicine, Department of Surgery, 720 Westview Drive SW, Atlanta, GA 30310-1495, United States.
authors.forename: Frank
authors.initials: F
authors.lastname: Jones
authors.affiliation: Morehouse School of Medicine, Department of Surgery, 720 Westview Drive SW, Atlanta, GA 30310-1495, United States.
authors.forename: Jacquelyn
authors.initials: J
authors.lastname: Turner
authors.affiliation: Morehouse School of Medicine, Department of Surgery, 720 Westview Drive SW, Atlanta, GA 30310-1495, United States.
authors.forename: Frederick
authors.initials: F
authors.lastname: Cason
authors.affiliation: Morehouse School of Medicine, Department of Surgery, 720 Westview Drive SW, Atlanta, GA 30310-1495, United States. Electronic address: cclark@msm.edu.
authors.forename: Clarence
authors.initials: C
authors.lastname: Clark
keywords: Flank hernia; Incisional hernia; Intercostal hernia; Post-surgical hernia