title: Rare cause of paraparesis: bilateral obturator neuropathy after hysterosalpingectomy.
abstract: Bilateral obturator nerve injury during pelvic surgery is an infrequent cause of lower limb paraparesis. We report the case of a 45-year-old woman with a large uterine leiomyoma who underwent simple total hysterectomy and bilateral salpingectomy. At 24 h after the surgery, the patient noticed loss of muscle strength when adducting both legs. She had no problem with other movements and no sensory or sphincter abnormalities. Neurological examination confirmed that there was loss of strength only in the adductor muscles, with preserved sensory function and reflexes, suggesting bilateral obturator nerve involvement. Pelvic MRI showed a small postsurgical haematoma in the Douglas recess, but far from the obturator nerves. 2 weeks later, electromyography showed positive sharp waves and low motor unit recruitment in the adductor magnus muscles, confirming acute, bilateral obturator nerve neuropathy. The few cases of bilateral obturator neuropathy that have been reported were mostly related to abdominopelvic interventions.
authors.affiliation: Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain Department of Neurology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: López-Blanco
authors.affiliation: Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Mejía-Jiménez
authors.affiliation: Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Carlos Pablo
authors.initials: CP
authors.lastname: de Fuenmayor-Fernández de la Hoz
authors.affiliation: Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Ruiz-Morales
mesh_terms: D005260:Female; D006801:Humans; D007044:Hysterectomy; D007889:Leiomyoma / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009776:Obturator Nerve; D020335:Paraparesis / Q000175:diagnosis* / Q000534:rehabilitation; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis* / Q000534:rehabilitation; D026741:Physical Therapy Modalities; D011183:Postoperative Complications / Q000175:diagnosis* / Q000534:rehabilitation; D058994:Salpingectomy; D014594:Uterine Neoplasms / Q000601:surgery*