Rare case of a strangulated intercostal flank hernia following open nephrectomy: A case report and review of literature

Highlights

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  Urgent abdominal examination with palpation of the region is necessary in the diagnosis of strangulated hernias but may be misleading so further studies are necessary.

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  Serological testing of a patient with a strangulated hernia may show lactic acidosis and leukocytosis.

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  Operative management is necessary for strangulated hernias especially in patients with altered mental status and a clinical picture showing decline.

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  Intercostal incisional herniation following a previous surgical procedure is a rare entity which should be diagnosed and treated rapidly.

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  This case highlights the clinical picture associated with an emergent strangulated hernia and highlights the critical steps in its management.

Abstract

Introduction

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.

Presentation of case

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.

Discussion

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.

Conclusion

Urgent diagnosis and treatment of this extremely rare hernia is paramount especially in the setting of strangulation.