Ilioinguinal/iliohypogastric neurectomy for management of intractable right lower quadrant pain after cesarean section: a case report.
BACKGROUND
Ilioinguinal nerve entrapment is one of the most common nerve injuries following pelvic surgery. We present a case of intractable right lower quadrant pain successfully treated with neurectomy.


METHODS
A 31-year-old woman, following her third elective cesarean section, noted intense, right inguinal pain immediately upon awaking from anesthesia. The pain was burning and constant and exacerbated by standing and movement. After a period of failed conservative management, a workup concluded probable nerve entrapment. Trigger point injections, amitriptyline and gabapentin therapy resulted in minimal improvement. At 10 months the patient underwent a right ilioinguinal neurectomy with excellent sustained pain relief.


CONCLUSIONS
Low transverse fascial incisions risk injury to the iliohypogastric and ilioinguinal nerves. While pain from entrapment of these nerves often resolves spontaneously, neurectomy may offer resolution in recalcitrant cases.
Whiteside
James L
JL
Section of Urogynecology and Reconstructive Surgery, Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Ohio, USA. james.l.whiteside@hitchcock.org
Barber
Matthew D
MD
D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007264:Inguinal Canal / Q000294:innervation*; D008160:Lumbosacral Plexus / Q000601:surgery*; D009392:Nephrectomy; D010146:Pain / Q000601:surgery*; D011247:Pregnancy; D016896:Treatment Outcome