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Case report
Abdominal flank bulge following intercostal neurectomy for symptomatic rib fracture nonunion
  1. Jonne T H Prins and
  2. Mathieu M E Wijffels
  1. Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
  1. Correspondence to Jonne T H Prins; j.prins{at}erasmusmc.nl

Abstract

The gold standard for rib fracture nonunion management remains a matter of debate. Operative treatment of rib fracture nonunion has become increasingly popular. A 69-year-old man was operatively treated with intercostal neurectomy of the left eighth rib to resolve chronic thoracic pain following a rib fracture nonunion. After the intervention, the patient developed a flank bulge which was most likely due to the intercostal neurectomy, causing partial denervation of the abdominal musculature. Although the pain at the nonunion site decreased after the operative intervention, the patient still experienced severe pain during daily activities and reported poor quality of life due to the flank bulge. Physiotherapy and an abdominal belt did not improve this flank bulge. When considering operative neurectomy of the intercostal nerves of ribs 7–12 to resolve chronic pain due to rib fracture nonunion, the treating surgeon should be aware of this debilitating complication.

  • pain
  • orthopaedic and trauma surgery
  • general surgery

https://doi.org/10.1136/bcr-2021-242041

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    Footnotes

    • Contributors MMEW and JTHP contributed to the preparation of this manuscript. MMEW was involved in the management of this patient and provided data to JTHP. JTHP drafted the main case report manuscript and researched previous literature to include in the case report. MMEW revised the manuscript critically. JTHP and MMEW approved the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.