Case Report
Intra-abdominal femoral nerve reconstruction following excision during right hemicolectomy

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Summary

Iatrogenic femoral nerve injury is an uncommon but recognised complication of abdominal and gynaecological surgery.

There have been several reported cases following colorectal surgery which specifically report transient femoral nerve neuropathies with variable but often full recovery. To our knowledge, this is the first documented case of femoral nerve reconstruction after iatrogenic resection during right hemicolectomy.

We present a case report of complete femoral nerve transection following abdominal surgery and discuss our management.

Introduction

Iatrogenic femoral nerve injury is an uncommon but recognised complication of abdominal and gynaecological surgery.1 Some authors have reported that this injury can occur at a rate of more than 10%2, 3 of such operations. Thin body habitus, the use of transverse abdominal incisions and self-retaining retractors are particular risk factors.4 With increased awareness of these risks, the incidence of this injury appears to have decreased.1, 4 There have been several reported cases following colorectal surgery which specifically report transient femoral nerve neuropathies with variable but often full recovery.5 However, Warner et al have reported the risk of persistent femoral neuropathy to be approximately 1 in 50,000 procedures performed in the lithotomy position.6

We present a case report of complete femoral nerve transection following abdominal surgery and discuss our management.

Section snippets

Case report

A 55 year male was referred to our department 5 weeks following a right hemicolectomy for an inflammatory caecal mass. In the immediate post-operative period he had been unable to extend his right knee and complained of severe pain and anaesthesia in the sensory distribution of the femoral nerve. Histolopathological analysis of the excised specimen had shown that the mass contained a large nerve bundle. There had been no recovery in the subsequent weeks.

Nerve conduction and EMG findings

Discussion

Previous authors have described femoral nerve neuropraxia following the use of retractors in abdominal surgery.4, 9 Tsuchihara et al10 describe 2 cases of iatrogenic femoral nerve injury after schwannoma resection. Gousheh and Razian11 reported 4 cases of femoral nerve injury following pelvic gunshot wounds and Kim et al12 reported 4 cases of femoral nerve injury requiring graft repair. To our knowledge, this is the first documented case of femoral nerve reconstruction after iatrogenic

Summary

The authors report a case of intra-abdominal femoral nerve resection during right hemicolectomy which was subsequently successfully reconstructed using interpositional nerve grafts. We wish to highlight this rare complication of abdominal surgery and would advocate early surgical exploration and repair in cases of nerve injury, even in older patients with suboptimal prognostic indicators for nerve regeneration. We would also reiterate that waiting for neurophysiology may delay inevitable

Acknowledgements

The senior author would like to thank Professor Rolfe Birch for helpful discussions in the initial management of this case.

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