We wanted to share some great news and celebrate with this patient who has had pain in the area of a previous surgical site in the abdominal wall that is now gone after identification of nerves that were trapped in the scar from the surgical site. This patient had pain for 5-6 years after a life saving operation was performed for him that required he have a colostomy. This procedure involved bringing the colon or large intestine to the abdominal wall and disconnecting it from it’s downstream end that goes to the rectum and anus. Fortunately for him this was temporary, and after several months he was able to go back to have the two ends of the colon put back together again to restore continuity and normal bowel function. Unfortunately, this patient had severe intense chronic abdominal wall pain in the location of the surgical scar. While some pain is normal for a few weeks as a patient heals, if the pain continues on for more than a few weeks and is severe, lancinating, sharp, stabbing, or electric, this is concerning for a nerve injury or a nerve that could be caught in the scar by mistake or by the normal act of wound healing. Unfortunately for this patient it continued for years. Other treatments did not seem to help. This pain affected his every day activities making each day a struggle.
We were able to find a very focal area of pain that made very good anatomic sense for a potential nerve entrapment. We suspected that a branch of the intercostal nerve called the anterior cutaneous branch of the intercostal nerve that just happens to travel to this area of the abdominal wall could have been inadvertently trapped in the scar tissue. We diagnosed this by his very clear history, and with the help of a nerve block to put this nerve to sleep. When his pain resolved with the nerve block, we were fairly certain that was the cause of his pain, and now the goal was to go find it.
We were able to find the nerve in the operating room and divide the nerve, which is expendable, and implant this nerve further back into the abdominal wall muscle where it is free from scar, deeper and more protected, to try to prevent recurrent neuroma formation and pain.
This patient has an immediate improvement in his original pain with this approach. We are celebrating with this patient today! This approach to small expendable (non-critical) nerves like the anterior cutaneous branches to the abdominal wall has been successful for many patients, and is a mainstay of treatment of these small but incredibly painful debilitating neuromas.