{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T12:12:02Z","timestamp":1783944722831,"version":"3.55.0"},"reference-count":23,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,7,2]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:p>Transdiaphragmatic intercostal hernias represent rare injuries resulting most commonly from blunt trauma. When extending into the intercostal and diaphragmatic regions, these hernias pose significant diagnostic and reconstructive challenges. We report the case of a patient with a right thoracoabdominal mass that was identified on a CT scan 4\u2009months after blunt thoracic trauma. Imaging revealed a large right posterior transdiaphragmatic hernia with intercostal extension between the 8th and 9th ribs, avulsion of the internal oblique and transversus abdominis muscles, and costal cartilage disinsertion. The hernia sac contained a small bowel segment, cecum, ascending colon and part of the right liver lobe, with a defect volume of more than 25% of the total abdominal volume. A multidisciplinary surgical management was performed, including prehabilitation with botulinum toxin A and combined abdominal wall and thoracic reconstruction aided by 3D virtual planning.<\/jats:p>","DOI":"10.1136\/bcr-2026-272403","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T11:35:12Z","timestamp":1783942512000},"page":"e272403","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["3D virtual planning and use of botulinum toxin A in prehabilitation of transdiaphragmatic intercostal hernia: a multidisciplinary approach"],"prefix":"10.1136","volume":"19","author":[{"given":"Pablo","family":"Guerrero-Antolino","sequence":"first","affiliation":[{"name":"General Surgery, University of Valencia, Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicent","family":"\u00dabeda","sequence":"additional","affiliation":[{"name":"Hospital La Fe, Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santiago","family":"Bonaf\u00e9-Diana","sequence":"additional","affiliation":[{"name":"Hospital La Fe, Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvador","family":"Pous-Serrano","sequence":"additional","affiliation":[{"name":"Hospital Universitari i Politecnic La Fe, Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"2026071304350781000_19.7.e272403.1","doi-asserted-by":"crossref","DOI":"10.4293\/CRSLS.2021.00061","article-title":"Robotic Repair of an Acquired Abdominal Intercostal Hernia","volume":"8","author":"Bergholz","year":"2021","journal-title":"CRSLS"},{"key":"2026071304350781000_19.7.e272403.2","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1007\/s10029-014-1232-x","article-title":"Acquired abdominal intercostal hernia: case report and systematic review of the literature","volume":"18","author":"Erdas","year":"2014","journal-title":"Hernia"},{"key":"2026071304350781000_19.7.e272403.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0095-5108(18)30201-X"},{"key":"2026071304350781000_19.7.e272403.4","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1093\/ejcts\/ezz020","article-title":"Unifying classification for transdiaphragmatic intercostal hernia and other costal margin injuries","volume":"56","author":"Gooseman","year":"2019","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026071304350781000_19.7.e272403.5","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1177\/000313480807400416","article-title":"Disruption of the costal margin with transdiaphragmatic abdominal herniation induced by coughing","volume":"74","author":"Chaar","year":"2008","journal-title":"Am Surg"},{"key":"2026071304350781000_19.7.e272403.6","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2021-247189","article-title":"Abdominal intercostal hernia and costal arch repair","volume":"14","author":"Moneim","year":"2021","journal-title":"BMJ Case Rep"},{"key":"2026071304350781000_19.7.e272403.7","doi-asserted-by":"crossref","DOI":"10.1007\/s00383-022-05303-y","article-title":"Minimal access surgery for congenital diaphragmatic hernia: surgical tricks to facilitate anchoring the patches to the ribs","volume":"39","author":"Mansour","year":"2023","journal-title":"Pediatr Surg Int"},{"key":"2026071304350781000_19.7.e272403.8","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1186\/s13019-023-02320-3","article-title":"Non traumatic acquired acute transdiaphragmatic intercostal hernia induced by coughing","volume":"18","author":"Lee","year":"2023","journal-title":"J Cardiothorac Surg"},{"key":"2026071304350781000_19.7.e272403.9","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1007\/s10029-021-02499-1","article-title":"A systematic review and meta-analysis of technical aspects and clinical outcomes of botulinum toxin prior to abdominal wall reconstruction","volume":"25","author":"Timmer","year":"2021","journal-title":"Hernia"},{"key":"2026071304350781000_19.7.e272403.10","doi-asserted-by":"crossref","unstructured":"Kerwan A , Al-Jabir A , Mathew G , et al . 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