Unusual Abdominal Wall Complication After a Bilateral Transversus Abdominis Plane Block for Postoperative Analgesia

TL;DR

A rare abdominal wall complication occurred after a TAP block, suggesting a noninfectious immune response to local anesthetics.

Contribution

Highlights a novel noninfectious autoinflammatory reaction linked to regional anesthesia procedures.

Findings

Rapid bilateral abdominal wall ulceration followed bilateral TAP block and local anesthetic infiltration.

Negative cultures and poor antibiotic response suggested an immune-mediated, noninfectious cause.

Surgical debridement improved the condition, emphasizing the need for early recognition of such reactions.

Abstract

Transversus abdominis plane (TAP) blocks are widely regarded as safe techniques for postoperative analgesia. We describe an unusual postoperative complication characterized by rapidly progressive bilateral abdominal wall ulceration following bilateral TAP block and infiltration of laparoscopic port sites with local anesthetics. The multifocal distribution, poor response to antibiotics, negative cultures, and association with procedural trauma raised strong concern for a sterile autoinflammatory dermatosis consistent with pyoderma gangrenosum or a related neutrophilic process, although a definitive diagnosis could not be confirmed. While pathergy remains the most widely accepted trigger for such reactions, an immune-mediated response to local anesthetic exposure may have contributed. The patient ultimately required surgical debridement with subsequent improvement. This case highlights the importance of recognizing noninfectious autoinflammatory wound reactions following regional anesthesia.

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