Lung hernia secondary to congenital absence of ribs.

It is usually assumed that lung hernia secondary to congenital absence of ribs is a great rarity. Perasalo and Laustela (1956) describing the latest published case, of a man aged 28 years, could not find any reference to this deformity in the literature and only one of the recently published books on paediatric surgery (Swenson, 1958) mentions the malformation. Perusal of the literature, however, does indicate that lung herniae are not so very uncommon. The earliest reported case is that by Rolland, writing in Guy de Chauliac's 'System of Surgery', in 1499. All early reports concerned lung hernias secondary to trauma or disease of the thoracic wall. The first congenital case to be reported was that of MorelLavallee in 1847. By 1933 Goodman was able to collect 172 cases of lung hernias of all types from the literature; about 18% of these were congenital. In practically all the congenital herniae of the lung reported in the literature the defect in the thoracic wall was small. In some the defect was due to absence of the para-sternal ends of one or two ribs; lung hernia secondary to complete absence of ribs is uncommon. Absent ribs are, of course, frequently encountered and are often associated with spinal deformities, but it is usually the first, second, eleventh or twelfth ribs which are absent, and absence of the most proximal or distal ribs does not commonly produce lung hernia. Few of the cases reported in the literature seem to have given rise to important symptoms during early infancy. The bulging hernia and paradoxical respiration were noticed, but the infants do not seem to have been unduly distressed. In later life, however, respiratory distress, cough, recurrent bronchitis and pain are common symptoms and have often necessitated operative correction. Various methods have been used in the treatment of congenital lung hernia. Tight bandaging of the chest wall does not appear to have been any good and has occasionally produced marked distress.