Advertisement

Ilioinguinal and Iliohypogastric Nerve Entrapment: Abdominal

  • Neel AminEmail author
  • Daniel Krashin
  • Andrea M. Trescot

Abstract

Ilioinguinal and iliohypogastric nerve entrapment is an under-recognized cause of abdominal and groin pain. These nerves can become entrapped after abdominal or hernia surgery and can result in disabling pain in the inguinal area or abdominal wall. The distribution and features of this pain can vary between patients, depending on anatomic variations in the course of the ilioinguinal and iliohypogastric nerves and the location of the entrapment. The pain can be diagnosed with nerve blocks and treated with neurolysis, neurectomy, or stimulation.

Keywords

Ilioinguinal nerve Iliohypogastric nerve Ilioinguinal nerve entrapment Iliohypogastric nerve entrapment Groin pain Post-hernia pain Abdominal wall pain 

Supplementary material

Video 40.1

Physical exam of the ilioinguinal and iliohypogastric nerves (MOV 69110 kb)

Video 40.2

Landmark-guided injection of the ilioinguinal nerve (MOV 58145 kb)

References

  1. 1.
    Ndiaye A, Diop M, Ndoye JM, Konate I, Ndiaye AI, Mane L, et al. Anatomical basis of neuropathies and damage to the ilioinguinal nerve during repairs of groin hernias. (about 100 dissections). Surg Radiol Anat. 2007;29(8):675–81.CrossRefPubMedGoogle Scholar
  2. 2.
    Stulz P, Pfeiffer KM. Peripheral nerve injuries resulting from common surgical procedures in the lower portion of the abdomen. Arch Surg. 1982;117(3):324–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Whiteside JL, Barber MD, Walters MD, Falcone T. Anatomy of ilioinguinal and iliohypogastric nerves in relation to trocar placement and low transverse incisions. Am J Obstet Gynecol. 2003;189(6):1574–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Kim DH, Murovic JA, Tiel RL, Kline DG. Surgical management of 33 ilioinguinal and iliohypogastric neuralgias at Louisiana State University Health Sciences Center. Neurosurgery. 2005;56(5):1013–20; discussion – 20.PubMedGoogle Scholar
  5. 5.
    Starling JR, Harms BA, Schroeder ME, Eichman PL. Diagnosis and treatment of genitofemoral and ilioinguinal entrapment neuralgia. Surgery. 1987;102(4):581–6.PubMedGoogle Scholar
  6. 6.
    Toussaint CP, Perry 3rd EC, Pisansky MT, Anderson DE. What’s new in the diagnosis and treatment of peripheral nerve entrapment neuropathies. Neurol Clin. 2010;28(4):979–1004.CrossRefPubMedGoogle Scholar
  7. 7.
    Hahn L. Treatment of ilioinguinal nerve entrapment – a randomized controlled trial. Acta Obstet Gynecol Scand. 2011;90(9):955–60.CrossRefPubMedGoogle Scholar
  8. 8.
    Eichenberger U, Greher M, Kapral S, Marhofer P, Wiest R, Remonda L, et al. Sonographic visualization and ultrasound-guided block of the third occipital nerve: prospective for a new method to diagnose C2-C3 zygapophysial joint pain. Anesthesiology. 2006;104(2):303–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Kopell HP, Thompson WA, Postel AH. Entrapment neuropathy of the ilioinguinal nerve. N Engl J Med. 1962;266(1):16–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Trescot AM. Cryoanalgesia in interventional pain management. Pain Physician. 2003;6(3):345–60.PubMedGoogle Scholar
  11. 11.
    Racz GB, Hagstrom D. Iliohypogastric and ilioinguinal nerve entrapment: diagnosis and treatment. Pain Dig. 1992;2:43–8.Google Scholar
  12. 12.
    Klaassen Z, Marshall E, Tubbs RS, Louis RGJ, Wartmann CT, Loukas M. Anatomy of the ilioinguinal and iliohypogastric nerves with observations of their spinal nerve contributions. Clin Anat. 2011;24:454–61.CrossRefPubMedGoogle Scholar
  13. 13.
    Knockaert DC, D’Heygere FG, Bobbaers HJ. Ilioinguinal nerve entrapment: a little-known cause of iliac fossa pain. Postgrad Med J. 1989;65(767):632–5.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Vuilleumier H, Hübner M, Demartines N. Neuropathy after herniorrhaphy: indication for surgical treatment and outcome. World J Surg. 2009;33(4):841–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Starling JR, Harms BA. Diagnosis and treatment of genitofemoral and ilioinguinal neuralgia. World J Surg. 1989;13(5):586–91.CrossRefPubMedGoogle Scholar
  16. 16.
    Giger U, Wente M, Büchler M, Krähenbühl S, Lerut J, Krähenbühl L. Endoscopic retroperitoneal neurectomy for chronic pain after groin surgery. Br J Surg. 2009;96(9):1076–81.CrossRefPubMedGoogle Scholar
  17. 17.
    Knockaert DC, Boonen AL, Bruyninckx FL, Bobbaers HJ. Electromyographic findings in ilioinguinal-iliohypogastric nerve entrapment syndrome. Acta Clin Belg. 1996;51(3):156–60.CrossRefPubMedGoogle Scholar
  18. 18.
    Suresh S, Patel A, Porfyris S, RYEE MY. Ultrasound–guided serial ilioinguinal nerve blocks for management of chronic groin pain secondary to ilioinguinal neuralgia in adolescents. Pediatr Anesth. 2008;18(8):775–8.CrossRefGoogle Scholar
  19. 19.
    Mitra R, Zeighami A, Mackey S. Pulsed radiofrequency for the treatment of chronic ilioinguinal neuropathy. Hernia. 2007;11(4):369–71.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Bischoff JM, Koscielniak-Nielsen ZJ, Kehlet H, Werner MU. Ultrasound-guided ilioinguinal/iliohypogastric nerve blocks for persistent inguinal postherniorrhaphy pain: a randomized, double-blind, placebo-controlled, crossover trial. Anesth Analg. 2012;114(6):1323–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Rab M, Ebmer J, Dellon LA. Anatomic variability of the ilioinguinal and genitofemoral nerve: implications for the treatment of groin pain. Plast Reconstr Surg. 2001;108(6):1618–23.CrossRefPubMedGoogle Scholar
  22. 22.
    Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367(9522):1618–25.CrossRefPubMedGoogle Scholar
  23. 23.
    Adler AC, Smith DI, Parikh PM. Chronic pain localized to the iliohypogastric nerve: treatment using an ultrasound-guided technique of hydrodissection for catheter placement as a guide for surgical iliohypogastric nerve resection. Plast Reconstr Surg. 2014;134(1):182e–3.CrossRefPubMedGoogle Scholar
  24. 24.
    Fanelli RD, DiSiena MR, Lui FY, Gersin KS. Cryoanalgesic ablation for the treatment of chronic postherniorrhaphy neuropathic pain. Surg Endosc. 2003;17(2):196–200.CrossRefPubMedGoogle Scholar
  25. 25.
    Hakeem A, Shanmugam V. Current trends in the diagnosis and management of post-herniorrhaphy chronic groin pain. World J Gastrointest Surg. 2011;3(6):73–81.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Kastler A, Aubry S, Piccand V, Hadjidekov G, Tiberghien F, Kastler B. Radiofrequency neurolysis versus local nerve infiltration in 42 patients with refractory chronic inguinal neuralgia. Pain Physician. 2012;15(3):237–44.PubMedGoogle Scholar
  27. 27.
    Rosendal F, Moir L, de Pennington N, Green AL, Aziz TZ. Successful treatment of testicular pain with peripheral nerve stimulation of the cutaneous branch of the ilioinguinal and genital branch of the genitofemoral nerves. Neuromodulation. 2013;16(2):121–4.CrossRefPubMedGoogle Scholar
  28. 28.
    Banh DP, Moujan PM, Haque Q, Han TH. Permanent implantation of peripheral nerve stimulator for combat injury-related ilioinguinal neuralgia. Pain Physician. 2013;16(6):E789–91.PubMedGoogle Scholar
  29. 29.
    Rauchwerger JJ, Giordano J, Rozen D, Kent JL, Greenspan J, Closson CW. On the therapeutic viability of peripheral nerve stimulation for ilioinguinal neuralgia: putative mechanisms and possible utility. Pain Pract. 2008;8(2):138–43.CrossRefPubMedGoogle Scholar
  30. 30.
    Zacest AC, Magill ST, Anderson VC, Burchiel KJ. Long-term outcome following ilioinguinal neurectomy for chronic pain. J Neurosurg. 2010;112(4):784–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Rosario DJ, Jacob S, Luntley J, Skinner PP, Raftery AT. Mechanism of femoral nerve palsy complicating percutaneous ilioinguinal field block. Br J Anaesth. 1997;78(3):314–6.CrossRefPubMedGoogle Scholar
  32. 32.
    Johr M, Sossai R. Colonic puncture during ilioinguinal nerve block in a child. Anesth Analg. 1999;88(5):1051–2.CrossRefPubMedGoogle Scholar
  33. 33.
    Vaisman J. Pelvic hematoma after an ilioinguinal nerve block for orchialgia. Anesth Analg. 2001;92:1048–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Anesthesiology and Pain MedicineAmerican Pain ExpertsFt. LauderdaleUSA
  2. 2.Pain and Anesthesia and Psychiatry Departments, Chronic Fatigue ClinicUniversity of WashingtonSeattleUSA
  3. 3.Pain and Headache CenterAnchorageUSA

Personalised recommendations