A 61-year-old male presented with complaints of nausea, abdominal pain, tenderness of the xiphoid process, and the feeling of “luxation” of the sternum, as if bones were sliding over each other as he describes. He quit smoking a few years earlier, which resulted in significant weight gain. The patient was an overweight mechanic (BMI 31.7 kg/m2), who worked on buses for which he often had to carry large tires. His current complaints however prevented him from being able to work. The symptoms were thought to be gastrooesophageal reflux, and the patient was analysed by a gastroenterologist who started treatment with a proton pump inhibitor. Upper gastrointestinal endoscopy revealed, apart from a small sliding diaphragmatic hernia (3 cm), no abnormalities. Cardiac pathology was ruled out by a cardiologist. Previously taken plain radiographs of the sternum before the weight gain showed a slight anterior displacement of the xiphoid process (). At three years after the onset of his complaints a second radiograph of the sternum was obtained, which showed progression of the anterior displacement of the xiphoid process (). This progression () was thought to be due to the patients' weight gain, causing anterior displacement as a result of pressure on the xiphoid process by the panniculus. A xiphoidectomy was performed. Postoperatively the patient experienced no more pain, and he could return to work. During eighteen months of follow-up, the patient reported none of the symptoms he complained of before.
During routine dissection of a fresh-frozen cadaveric specimen, a 44-year-old at death Caucasian male was found to have an elongated and hook-shaped xiphoid process that protruded dorsally (). Measurements were taken using a digital microcaliper (Mitutoyo, Kanagaw, Japan). The measured length, width, and thickness of the xiphoid process were 54.2 mm, 17.1 mm, and 4.6 mm, respectively. Sternal body and manubrium lengths were 83.5 mm and 60.0 mm, respectively. The angle from the sternal body to xiphoid process was 167°. The attachments of the muscles to the sternum, including the xiphoid process, were normal. During extraction of the sternum from the rib cage, the manubrium was slightly fractured but no other anatomical variations were identified.