Ramsden Christopher Edward, McDaniel Michael Craig, Harmon Robert L, Renney Kenneth M, Faure Alexis
School of Medicine, Medical College of Georgia, Augusta, Georgia, USA.
Am J Phys Med Rehabil. 2003 Jun;82(6):479-84.
Perineal pain caused by pudendal nerve entrapment is a rarely reported entity, with only a handful of cases in the modern literature. A 25-yr-old male medical student had refractory unilateral orchialgia for 32 mo and concomitant proctalgia for 14 mo. Pain was positional in nature, exacerbated by sitting and partially relieved when standing or recumbent. Pudendal nerve entrapment was diagnosed clinically, with computed tomography-guided nerve blocks providing temporary relief. A prolonged left pudendal nerve distal motor latency on electrodiagnostic testing later confirmed the diagnosis. At surgery, the left pudendal nerve was found flattened in the pudendal canal of Alcock and in contact with the sharp inferior border of the sacrospinous ligament. After surgical decompression and rehabilitation, the patient experienced significant relief of pain and returned to medical school. This case suggests pudendal nerve entrapment should be considered in the differential diagnosis of chronic urogenital or anorectal pain, particularly if the pain is aggravated by sitting or if there is a history of bicycle riding.
由阴部神经卡压引起的会阴痛是一种鲜有报道的病症，现代文献中仅有少数病例。一名25岁的男性医学生单侧睾丸疼痛难治32个月，同时伴有直肠疼痛14个月。疼痛具有体位性，坐位时加重，站立或卧位时部分缓解。临床诊断为阴部神经卡压，计算机断层扫描引导下的神经阻滞提供了暂时缓解。电诊断测试中左侧阴部神经远端运动潜伏期延长后来证实了诊断。手术时，发现左侧阴部神经在阿尔科克阴部管内变扁平，并与骶棘韧带锐利的下缘接触。经过手术减压和康复治疗，患者疼痛明显缓解并重返医学院。该病例表明，在慢性泌尿生殖系统或肛肠疼痛的鉴别诊断中应考虑阴部神经卡压，特别是如果疼痛因坐位而加重或有骑自行车史。
