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Ilioinguinal Neuralgia

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Anatomy

Main article: Ilioinguinal Nerve

The ilioinguinal nerve originates from the L1 nerve root along with the iliohypogastric nerve. It is a mixed nerve providing motor supply to the Internal Oblique and Transversus Abdominis muscles, and sensory supply to the anterior one third of the scrotum/labia and root of the penis/clitoris, as well as to the superior medial thigh.

Aetiology

Due to their specific location and varying course, they are prone to damage during surgical operations involving the lower abdomen. Such injuries are recognized risks in procedures like open appendicectomy, inguinal hernia repair, low transverse incisions (like the Pfannenstiel incision), and during trocar insertion in laparoscopic surgeries of the abdomen and pelvis. These nerves can sustain damage through various means, such as direct trauma, with or without neuroma formation, nerve compression by scar tissue or haematoma, or being sutured into fascial closure or mesh incorporation.

  • Post-surgical
    • Inguinal hernia repair
    • Traumatic trochar from laparoscopic surgery
    • Appendectomy and hysterectomy
    • Abdominoplasty
    • Orchiectomy
  • Other Trauma
    • Blunt abdominal trauma
    • Femoral catheterization
    • Lower external oblique aponeurosis disruption (hockey players)
  • Pregnancy
  • Idiopathic, entrapment at:
    • Paravertebral area
    • Iliac crest
    • Rectus border muscle
    • Inguinal region

Clinical Features

Typically, patients with pain resulting from irritation of these nerves report groin pain that may extend to the scrotum or testicle in males, the labia majora in females, and the inner part of the thigh.

Diagnosis

Main article: Ilioinguinal Nerve Injection

Blocking the ilioinguinal and iliohypogastric nerves (they lie within the same fascial plane) can serve a diagnostic and therapeutic role in patients reporting chronic pain in this nerve distribution.

Differential Diagnosis

Differential Diagnosis

References

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