The surgical management of intercostal lung herniation using bioprosthesis

Abstract

Lung hernia is a rare occurrence. Consequently there is little literature providing guidance to effective management. Classified as congenital or acquired, there are fewer than 300 cases described in current literature (1). We describe a unique method for the management of spontaneous rib fractures and, resulting posterior lung herniation in a 65 year old man following a bout of coughing.

Figure 1

Left lung hernia

Figure 2

Rendered images of fractured ribs 6, 7 and 8 Arrowheads demonstrating fractures of the left 6th, 7th and 8th ribs. * = site of skeletal defect and subsequent site of pulmonary herniation

Figure 3

The mobilised latisssimus dorsis

Figure 4

The hernial defect

Figure 5

Anchoring sutures, latissimus dorsi replaced

Figure 6

The PermacolTM bioprosthesis placement

Figure 7

The PermacolTM bioprosthesis (Anterior and Posterior view) Latissimus Dorsi is reflected posteriorly and anteriorly respectively

Figure 8

Local anaesthetic wound catheter

Figure 9

Postoperative rendered images confirming restoration of herniated lung Top left, CT demonstrating PermacolTM patch in situ. Rendered images display areas of resected ribs and the revised bony form. Lung is restored and shows no evidence of herniation.