Paralysis of the rectus abdominis muscle after video-assisted thoracoscopic surgery for recurrent spontaneous pneumothorax.

Clinically apparent injury to an intercostal nerve associated with paralysis of the upper rectus abdominis is a rare complication of video-assisted thoracoscopic surgery (VATS), with no reports available in the pediatric literature. We present the case of a 16-year-old boy who underwent VATS blebectomy and pleurodesis followed by tube thoracostomy for recurrent spontaneous pneumothorax. Definitive reexpansion of the lung was achieved with no immediate complications, but the child complained of abnormal sensation and motor dysfunction of the left upper rectus at his first follow-up visit 2 weeks after the operation. Isolated muscular paralysis persisted at 2-month follow-up, although there was no associated activity limitation. Video-assisted thoracoscopic surgery is now a common practice and recognized as less morbid than open thoracotomy, but there exists scant literature regarding intercostal nerve injury and associated rectus abdominis paralysis. This report reviews the relevant published literature, with emphasis on the mechanism of nerve injury and avoidance of this complication.