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

## TL;DR

A rare case of a spontaneous transdiaphragmatic intercostal hernia in an elderly man was successfully treated with laparoscopic repair.

## Contribution

This paper presents a rare spontaneous case of transdiaphragmatic intercostal hernia and demonstrates the effectiveness of laparoscopic repair.

## Key findings

- A 71-year-old man with no trauma history developed a spontaneous transdiaphragmatic intercostal hernia.
- Laparoscopic repair with mesh reinforcement led to uneventful recovery and no recurrence at 8 months.
- Obesity and chronic immunosuppression were identified as contributing factors.

## 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.