Douleur chronique post-thoracotomie révélant une large hernie pulmonaire : prise en charge chirurgicale curative 32 ans plus tard

A 54-year-old man consulted for left chest chronic pain evolving for 2 years. His job consisted in lifting heavy load in a market. His medical history found a notion of left posterolateral thoracotomy in 1979. Interrogation found a pain localized around the thoracotomy and inframammary, neurological in form (burning, tingling, numbness, and neuralgia), and mechanical (stretching, feeling of heaviness). This pain gradually worsened, with paroxysms after a major effort from the onset of symptoms. Treatment with carbamazepine prescribed increments up to 600 mg per day resulted in a clinical improvement. Clinical examination found a large arch mainly after Valsalva maneuvers. The chest radiograph objectified loss of bone with clarity image outside of the chest wall. The diagnosis of wide pulmonary hernia was obvious. The intervention consisted of a reduction of the hernia sac, and strengthening the chest wall by a non-absorbable mesh polyethylene terephthalate (type Mersuture*). The postoperative course was uneventful. The patient was discharged from hospital after a week. Chest X-ray control was satisfactory. Treatment of discharge was as paracetamol 1 g three times a day, and always as carbamazepine at a dose of 600 mg per day with gradual decrease until it stops after 4 months. After 21 months of decline, the patient is asymptomatic, with good rigidity of the chest wall.