Spontaneous Chest Wall Herniation in Centrally Obese Patients: A Single-Center Experience of a Rare Problem

Jillian Sinopoli; Andrew Strong; Matthew Kroh; Matthew Allemang; Daniel P Raymond

doi:10.1177/0003134820950280

Spontaneous Chest Wall Herniation in Centrally Obese Patients: A Single-Center Experience of a Rare Problem

Am Surg. 2021 Feb;87(2):222-227. doi: 10.1177/0003134820950280. Epub 2020 Sep 15.

Authors

Jillian Sinopoli¹, Andrew Strong², Matthew Kroh³, Matthew Allemang⁴, Daniel P Raymond⁵

Affiliations

¹ Thoracic Department, Brigham & Women's Hospital, Boston, MA, USA.
² 443553 General Surgery Department, The Cleveland Clinic, Cleveland, OH, USA.
³ General and Bariatric Surgery, Digestive Disease Institute, The Cleveland Clinic, Abu Dhabi, UAE.
⁴ General Surgery Department, Minimally Invasive Surgery, The Cleveland Clinic, South Pointe Hospital, Warrensville Heights, OH, USA.
⁵ General Thoracic Surgery, Center for Chest Wall Disease, The Cleveland Clinic, Cleveland, OH, USA.

PMID: 32927964
DOI: 10.1177/0003134820950280

Abstract

Background: Spontaneous rib fractures, especially in association with chest wall herniation, represent an uncommon pathology. As such, there are little data analyzing approaches to treatment or regarding the success of intervention. The goal of this study was to analyze our cumulative experience with this unusual condition.

Methods: A case series of 12 patients was gathered from a single institution based on outpatient visits between February 2015 and October 2018. Each chart was retrospectively reviewed with particular attention to age, gender, BMI, area of injury, and smoking history. Patients presented with complaints of dyspnea or pain related to rib fractures with or without intercostal neuralgia. Each of these patients was noted to have rib fractures with lung herniation either on imaging, outside hospital records, or physical exam. A thorough medical history was obtained with attempts to find common predisposing factors as well as data regarding any previous surgical intervention for their herniation.

Results: Nine of the 12 patients reviewed had recent or prior surgical intervention. Every patient seen in the clinic with a spontaneous fracture and herniation incidentally had a BMI >30 and was therefore classified as obese. Additionally, every patient who had a recurrence after their first surgical attempt at repair had a BMI greater than or equal to 35. All 12 patients seen at our institution were males. The failure rate of operative intervention was 66%.

Conclusions: Obesity was a prevalent comorbidity in the patient population we reviewed. Given the role obesity plays in abdominal and hiatal hernia repair success rates, it should be considered that obesity is a significant contributor to chest wall herniation if rib fractures occur. With 66% chest wall repair failure, patient selection is critical in the success of surgical intervention. Perhaps additional patient optimization, especially weight loss, should be considered prior to surgery.

Keywords: chest wall; herniation; obesity; rib fracture; spontaneous.

MeSH terms

Adult
Age Factors
Body Mass Index
Chest Pain / etiology
Dyspnea / etiology
Female
Hernia / diagnosis
Hernia / etiology*
Hernia / pathology
Herniorrhaphy
Humans
Male
Middle Aged
Obesity, Abdominal / complications*
Obesity, Abdominal / pathology
Rib Fractures / diagnosis
Rib Fractures / etiology
Rib Fractures / pathology
Risk Factors
Sex Factors
Thoracic Wall* / pathology
Thoracic Wall* / surgery