Surgical management of post-surgical intercostal thoracic-abdominal nerve neuroma

Abstract

Background Formation of post-operative neuroma formation after laparoscopic surgery is not common. Its diagnosis is often missed because pain often mimics intra-abdominal pathology. In this paper, the authors report a case in which the severe pain resulting from the abovementioned neuroma was successfully treated by excision of neuroma and implant of the proximal stump into the adjacent muscle. Case presentation The patient is a 20-year-old female who had laparoscopic surgery on her left kidney. Immediately after surgery, she started experiencing severe pain at the operative site that continued for 5 years. A recent nerve block of the thoracic-abdominal intercostal nerve deep in the abdominal wall immediately beneath the incision gave her temporary relief for a couple of weeks. The patient was operated on. The neuroma was identified in the scar tissue of the transversalis muscle. The neuroma was excised, and the proximal stump was buried in the adjacent muscle. After the operation, she was free of pain and continues to be free of pain at 6 months follow-up. Conclusion Formation of neuroma with severe chronic abdominal pain can occur after laparoscopic surgery. Nerve block is a diagnostic study for this condition. Neuroma resection with burying the covering of the stump can result in the cure of the pain.