Atraumatic Transdiaphragmatic Intercostal Hernia Following a Coughing Spell: A Case Report.

Transdiaphragmatic intercostal herniations are rare clinical entities that require precise management. Although risk factors are not well established, these defects do occur in clinical practice. Of the several reported cases of transdiaphragmatic intercostal hernias, few have involved the liver and large bowel. The present case illustrates a rare finding of a 60-year-old male patient who presented to the emergency department experiencing severe pain and shortness of breath after feeling a "pop" on the right side of his chest following a violent episode of coughing that had been ongoing for a couple of days. Imaging revealed a right seventh rib fracture with herniation and incarceration of the liver and large bowel within the intercostal space. Our case highlights the importance of diagnostic imaging, clinical management, and surgical considerations when managing patients with this rare surgical entity.