AB264. SOH26AB_0063. Case report of ultrasound-guided transverse abdominal plane hydrodissection: a novel approach for the treatment of parastomal hernia pain

Background: Abdominal parastomal hernia pain is a common complication in patients who undergo stoma formation. The aetiology of the pain may be secondary to nerve damage and entrapment secondary to scar tissue formation. Chronic post-surgical pain is the most impacting factor on quality of life in these patients. Hydrodissection is a minimally invasive technique involving the injection of fluid (5% dextrose) to separate layers of fascia to release entrapped nerves. It is emerging as a potential treatment for nerve entrapment.

Case Description: A case report of a 47-year-old patient with a parastomal hernia and associated ongoing pain not suitable for surgical repair. Pain localized to the lateral flank. Surgical history included six abdominal surgical interventions and Crohn’s disease. The pain was not adequately controlled with oral analgesia. Intervention: the patient underwent ultrasound-guided transverse abdominal plane (TAP) block hydrodissection with a 20-G needle. Twenty mL of 5% dextrose solution was used to address perineural inflammation and neuronal adhesions. Under detailed ultrasound examination, hyperechoic areas were identified laterally, and ultrasound hydrodissection was performed. Follow-up at 2 months demonstrated resolution of lateral flank pain.

Conclusions: TAP hydrodissection is a safe minimally invasive treatment for patients suffering abdominal wall pain secondary to parastomal hernias. This is a promising alternative to more invasive interventions, warranting further investigation into hydrodissection for post-surgical abdominal wall pain.

Keywords: Hydrodissection; parastomal pain; transverse abdominal plane (TAP); Crohn’s; case report