Repair of a chest wall hernia after dirt bike collision: a case report

Traumatic chest wall herniation involving lung is a rare phenomenon, especially in pediatric patients. We present a unique thoracoscopic approach to management with excellent functional and cosmetic results. A 15-year-old male sustained a traumatic disruption of the right third costochondral junction after a dirt bike accident. The right upper lobe herniated through this defect. Thoracoscopy revealed a 10cm x 5cm anterior chest wall defect with adherent parenchyma. The lung was reduced using a combination of blunt dissection and external pressure. A non-anatomic wedge resection of the injured lung was performed to prevent postoperative air leak. The right third rib demonstrated a clear fracture and malalignment so it was reapproximated with an 18-hole resorbable rib plate with small stab incisions. A Vicryl mesh patch was used to overlap the margins of the defect and fixated circumferentially with an absorbable tacker to restore chest wall integrity. We then performed cryoablation of the surrounding ribs, nerve blocks, and application of pleural sealant. A chest tube was placed, and the lung was directly reinflated. The patient did well and was discharged home on postoperative day one. At his follow up one and two months later, he had complete clinical and radiographic healing with return to baseline activity. Lung herniation following chest wall trauma is rare. Thoracoscopic repair with absorbable materials in an adolescent is possible and should allow for continued chest wall growth.