doi 10.17992/lbl.2026.0708.902

Correspondence: Bjarni Geir Viðarsson, bjarnigv@landspitali.is

Key words: Transdiaphragmatic intercostal hernia, abdominal surgery, general thoracic, non-traumatic, case report.

Transdiaphragmatic intercostal hernias (TDIH) are rare and occur when abdominal viscera herniate through diaphragmatic and intercostal defects. They are often associated with trauma, but spontaneous cases (e.g., related to coughing) have also been described. We report a case of a male in his seventies with chronic obstructive pulmonary disease and obesity who developed TDIH following severe coughing due to a respiratory infection. Imaging revealed a right-sided diaphragmatic hernia with colon and small intestines extending into the thoracic cavity and between ribs. The patient underwent a successful open repair with a Gore-Tex mesh reinforcement for both diaphragmatic and intercostal defects.

Figure 1

Figure i: Visible protrusion at the right costal margin caused by herniation through the 6th-7th intercostal space and ii) a coronal computed tomography (CT) scan demonstrating intra-abdominal organs herniating through the diaphragm and into the 6th-7th intercostal space.

Figure ii: Resolution of the bulge at the right thorax following surgery, and ii) a CT scan obtained three months after surgery demonstrates no recurrence of the diaphragmatic hernia.