Neuropathic inguinal pain due to nerve injury after a laparoscopic appendectomy: first pediatric case described in the literature
| Autor: | Javier Robla Costales, Esteban Quevedo Orrego, Adán González Álvarez, Carlos Alberto Rodríguez Aceves, Rubén Diana Martín, Mariano Socolovsky |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
medicine.medical_specialty Adolescent Hernia Inguinal 030230 surgery Groin 03 medical and health sciences 0302 clinical medicine Analgesic therapy medicine Appendectomy Humans Child Neurolysis Herniorrhaphy Iliohypogastric nerve business.industry General Medicine Nerve injury Surgery Allodynia 030220 oncology & carcinogenesis Skin hyperpigmentation Pediatrics Perinatology and Child Health Female Laparoscopy Neurology (clinical) Neurosurgery medicine.symptom business Pediatric population |
| Zdroj: | Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. 37(6) |
| ISSN: | 1433-0350 |
| Popis: | To describe the first pediatric case in the literature of neuropathic inguinal pain secondary to iatrogenic nerve injury that occurred during a laparoscopic appendectomy, detailing clinical and morphological findings before and after surgery. The literature on adult patients is reviewed and pathophysiological, therapeutic, and prognostic factors are discussed. A 14-year-old female patient presented with a history of a laparoscopic appendectomy 3 years previously. Three months post-operatively, she developed progressively worsening neuropathic inguinal pain refractory to neuromodulators and several nerve blocks. Given her deterioration, poor response to conservative therapy, and clearly meeting the criteria for chronic post-operative inguinal pain (CPIP), surgical management was undertaken. Open surgery was performed through the previous incision, during which injury to a branch of the iliohypogastric nerve (IH) was confirmed. Neurolysis of the affected branch was performed, after which the patient experienced significant pain relief, resolution of allodynia, and reversal of skin hyperpigmentation. After discharge, analgesic therapy was gradually withdrawn and, ultimately, discontinued altogether. Understanding the neuroanatomy of the inguinal region is an indispensable requirement for all surgeons operating in this region, to avoid complications including CPIP and optimize patient outcomes. Surgical management of CPIP can be effective for controlling severe pain in patients in whom conservative management has failed. Studies are needed in the pediatric population to identify specific characteristics of this entity in youth. |
| Databáze: | OpenAIRE |
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