gms | German Medical Science

Objective: Objectives: Chest wall hernias are classified as diaphragmatic, thoracic and cervical and may be acquired or congenital. Acquired hernias mainly occur after blunt trauma or thoracic surgery. In contrast to these, spontaneous chest wall hernias are rarely described in the literature and require an abnormal rise in intrathoracic pressure associated with straining or coughing in conjunction with localized weakness of the chest wall.

Methods: Methods: Between 2011 and 2013 five consecutive patients were referred to our service with spontaneous chest wall hernias. All patients were men with a mean age of 55 (41–71) ys and a high mean BMI of 31 (23–38). One patient received corticoids for COPD treatment and one 41-year-old patient was diagnosed with osteoporosis.

Results: All five patients presented with spontaneous rib fractures with pseudoarthroses and associated severe rib diastasis. Surgery included resection of the hernial sac and the pseudoarthroses, closure of the intercostal gap, rib stabilization with metallic struts and chest wall enforcement with porcine dermal collagen patch. In all patients more than one (2–4) surgical intervention for recurrences were required to achieve good final results.

Conclusion: Spontaneous chest wall hernias may be provoked through chest wall weakness due to fatty degeneration of the intercostal muscles, osteoporosis or corticoid therapy and may constitute considerable therapeutic difficulties requiring repeated surgical interventions to stabilize the chest wall.