The lower intercostal muscles (ribs 7-12) have tendinous components at their costal cartilage attachments that blend with the external oblique aponeurosis. These tendinous attachments form the thoracoabdominal junction of the musculofascial wall.
The lower intercostal tendinous attachments are relevant in subcostal approaches to the retroperitoneum, where the lower intercostal muscles and their tendinous costal margins are divided. Hernia through a subcostal incision involves disruption of these lower intercostal tendinous attachments. Flank pain from lower intercostal tendinopathy mimics renal colic.
Hernia through a subcostal flank incision from division of the lower intercostal tendinous attachments, producing a reducible lateral abdominal wall bulge managed by component separation hernia repair.
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