Treatment of Bilateral Abdominal Wall Neuroma-in-Continuity Due to Kiteboarding Injury with Processed Nerve Allografts
Jenna Rose Stoehr, B.A.1, Ava G Chappell, MD1 and Gregory A Dumanian, MD2, (1)Northwestern University Feinberg School of Medicine, Chicago, IL, (2)Northwestern University, Chicago, IL
Introduction: Nerve injury can result in chronic pain and significantly reduced quality of life. Surgical innovations have led to increased awareness and improved management of painful nerves, but they are still often underdiagnosed and untreated. Processed nerve allograft (PNA) may be utilized in the management of both terminal neuroma and neuroma-in-continuity (NIC). Here, we present the first reported case of NIC due to blunt trauma from kiteboarding, and its successful treatment using PNA.
Materials and Methods: The patient is a 36-year-old man without prior medical history who presented with debilitating, chronic abdominal wall pain due to bilateral intercostal NIC. The pain began after a time period when he was regularly kiteboarding, and it impacted his ability to exercise and perform his activities of daily living. He had undergone extensive testing and attempted many treatments prior to presentation, including medication, nerve blocks, nonmedical therapy, and surgery. His exam was significant for two near-symmetric areas that were tender to palpation in the subcostal abdomen. He underwent excision and reconstruction with two 2-cm segments of PNA.
Results: At six weeks, the patient reported a significant reduction in pain. At one-year follow-up, the patient reported complete alleviation of his pain. He was able to resume all normal activities and discontinue pain medications.
Conclusions: While managing patients with chronic abdominal pain, providers must consider neuroma in their differential diagnoses and be aware of its treatment options. The patient in this case underwent a substantial delay in treatment due to misdiagnosis. Kiteboarding is a unique mechanism of peripheral nerve injury that has not previously been reported in the literature. This report demonstrates the efficacy of PNA in the management of NIC of the abdominal wall, as well as the importance of being aware of unusual manners of nerve injury.
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