Spontaneous Transdiaphragmatic Intercostal Hernia in an Elderly Patient: A Rare Case Treated by Laparoscopic Repair.

Abstract

Transdiaphragmatic intercostal hernia is a rare entity, with fewer than 50 cases reported in the literature. The majority are post-traumatic, secondary to blunt or penetrating thoracic injuries. Spontaneous forms are exceptional and often associated with risk factors such as obesity, chronic pulmonary disease, or long-term corticosteroid and immunosuppressive therapy. We present the case of a 71-year-old man with no history of trauma, who developed progressive dyspnea and subocclusive symptoms over several months. Imaging revealed a left transdiaphragmatic intercostal hernia between the seventh and eighth ribs, containing small bowel, colon, and omentum. The patient underwent laparoscopic repair with mesh reinforcement. Postoperative recovery was uneventful, with significant clinical improvement and no recurrence at eight-month follow-up. At that point, the patient reported localized neuropathic pain without radiological evidence of recurrence. This case highlights the rare occurrence of spontaneous transdiaphragmatic intercostal hernia, underlining the role of obesity and chronic immunosuppression as contributing factors, and emphasizes the diagnostic challenge of this condition as well as the feasibility and effectiveness of a laparoscopic mesh repair strategy.