CASE 11591 Published on 10.04.2014

Herniation of the liver through sternotomy incision


Abdominal imaging

Case Type

Clinical Cases


Itsaso Barral1, Jose Angel Torena1, Arantza Olaizola2

(1) Radiology Department
(2) Surgery Department

Hospital Bidasoa,
Hondarribia, Spain

90 years, female

Area of Interest Abdomen ; Imaging Technique CT
Clinical History
Female patient, 90 years old. The patient presented at the Emergency Department with epigastric pain, nausea and vomiting. History of hernia after sternotomy.
Imaging Findings
CT with intravenous contrast was performed in venous and late phases, in which an epigastric hernia containing part of the left hepatic lobe was observed.
The herniated liver parenchyma showed hypodense appearance in venous phase (Fig.1 and 2) and isodensity in late phase, due to vascular compromise. Hernia contained minimal free fluid (Fig. 3).
The patient underwent emergency surgery, the hernia was reduced and repaired with a mesh. The evolution was satisfactory, and the patient was discharged four days later.
Herniation of the liver is uncommon. Hepatic herniation through the abdominal wall is a very rare phenomenon. Liver herniation through subxiphoid incision is a rare complication after median sternotomy. Most cases have been secondary to trauma (associated with diaphragmatic rupture) and congenital diaphragmatic hernias have also been described [1].
Herniation of the liver through the sternotomy incision usually occurs 2 to 3 years after surgery. The most frequent risk factors are obesity, postoperative infection and female gender [3].
The clinical presentation of liver herniation through an anterior abdominal wall hernia tends to be non-acute, probably because the hernial orifice is usually large and this makes strangulation of herniated contents difficult [1].
The most common symptoms are abdominal pain, nausea and vomiting and an epigastric hernia on physical examination [1].
The CT is the indicated imaging technique to diagnose and assess the extent and characteristics of the hernia. CT with intravenous contrast also helps us to know the situation and viability of the hepatic parenchyma [3].
The treatment of these hernias will depend on clinical condition of the patient. In asymptomatic patients conservative treatment can be performed, and in cases where symptoms are present surgical treatment is the method of choice. Surgery is performed to correct the defect wall (open surgery or laparoscopy) [2].
Differential Diagnosis List
Herniation of the liver through sternotomy incision
Abdominal wall neoplasia
Abdominal wall haematoma
Final Diagnosis
Herniation of the liver through sternotomy incision
Case information
DOI: 10.1594/EURORAD/CASE.11591
ISSN: 1563-4086