Management of a thoracoabdominal hernia following rib resection for osteomyelitis (a case report)

Thoracoabdominal hernias (TAH) are rare and insufficiently studied conditions. They are characterized by heterogeneous defect topography involving the thoracic and abdominal wall muscles, diaphragm, and osteochondral structures. Surgical management includes open, laparoscopic, and robotic approaches. The aim of this article was to present a clinical case of a thoracoabdominal hernia that developed after surgical treatment of a suppurated atheroma complicated by costal arch perichondritis and rib osteomyelitis. Case report. A 49-year-old female patient underwent multiple surgeries since 2018 for a suppurated atheroma in the left epigastric region. The course was complicated by perichondritis of the costal arch and osteomyelitis of ribs VII–X, requiring rib resection with omentoplasty. A large thoracoabdominal hernia subsequently developed in the resection area, extending to the epigastric and left hypochondriac regions, with progressive enlargement and severe pain. The patient was admitted to a thoracic surgery department. Open anterior combined hernioplasty with a polypropylene mesh was performed. The postoperative course was uneventful; no recurrence was observed during a 3-month follow-up. Conclusion. The anterior combined prosthetic repair enabled effective defect closure and provided favorable functional and cosmetic outcomes. The technique does not require specialized equipment or metallic fixation devices, is relatively minimally invasive, and preserves the mobility of the thoracic and abdominal walls, which is of physiological importance.