title: Flank pseudohernia following posterior rib fracture: a case report.
abstract: BACKGROUND
  A pseudohernia is an abdominal wall bulge that may be mistaken for a hernia but that lacks the disruption of the abdominal wall that characterizes a hernia. Thus, the natural history and treatment of this condition differ from those of a hernia. This is the first report of a pseudohernia due to cough-associated rib fracture.
  
  
  METHODS
  A case of pseudohernia due to fractures of the 10thand 11thribs in a 68-year-old white woman is presented. The patient suffered from a major coughing episode 1 year prior to her presentation, after which she noted a progressively enlarging bulge in her left flank. Computed tomography demonstrated a bulge in the abdominal wall containing bowel and spleen but with all muscle and fascial layers intact; in addition, lateral 10thrib and posterior 11thrib fractures were noted.
  
  
  CONCLUSIONS
  As there was no defect in muscle or fascia, we diagnosed a pseudohernia, likely due to a denervation injury from the fractured ribs. Symptomatic treatment was recommended, including wearing a corset and referral to a pain management clinic. Symptomatic treatment is thought to be the mainstay of therapy for pseudohernias, as surgical intervention is unlikely to be of benefit.
authors.affiliation: Columbia University College of Physicians and Surgeons, 5141 Broadway, Suite 3-170, New York, NY, 10034, USA.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Butensky
authors.affiliation: Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Leah P
authors.initials: LP
authors.lastname: Gruss
authors.affiliation: Department of Surgery, Columbia University College of Physicians and Surgeons, 5141 Broadway, Suite 3-170, New York, NY, 10034, USA. zlg1@cumc.columbia.edu.
authors.forename: Zachary L
authors.identifier: http://orcid.org/0000-0002-3957-5704
authors.initials: ZL
authors.lastname: Gleit
mesh_terms: D034861:Abdominal Wall / Q000000981:diagnostic imaging / Q000473:pathology*; D000368:Aged; D003371:Cough / Q000150:complications*; D005260:Female; D021501:Flank Pain / Q000000981:diagnostic imaging / Q000209:etiology*; D046449:Hernia, Abdominal / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D009989:Orthotic Devices; D059408:Pain Management; D012017:Referral and Consultation; D012253:Rib Fractures / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D014057:Tomography, X-Ray Computed
keywords: Case report; Hernia; Pseudohernia; Rib fracture