Ilioinguinal Neuralgia

Ilioinguinal neuralgia is a frequent cause of pain in the lower abdomen and the upper thigh caused by an injury or damage to the nerve. The ilioinguinal nerve is a mixed nerve originating from the anterior rami of T12 and L1 nerve roots. The nerve emerges near the lateral border of the psoas major muscle and goes inferior through the anterior abdominal wall, subperitoneal, and anterior to the quadratus lumborum muscle until it reaches the iliac crest. Then, the ilioinguinal nerve passes through the transverse abdominis and internal oblique muscles. It becomes superficial after passing through the external inguinal ring anterior to the spermatic cord in males and the round ligament in females. It gives motor innervation to the transverse abdominis and the internal oblique muscles. The ilioinguinal nerve also carries sensory information from the anterior surface of the scrotum and root of the penis in males or labia majora and mons pubis in females as well as a small area of the upper anteromedial thigh. Because of its long course, entrapment or injury of the ilioinguinal nerve after various lower abdomen surgeries is common, with both male and female patients complaining of varying degrees of pain, paresthesia, and abnormal sensation in the area it supplies. Diagnosis of ilioinguinal neuralgia requires a careful history, physical examination, electrophysiologic studies, and ultrasound examination. Treatment of ilioinguinal neuralgia usually starts with conservative measures, including oral analgesics, anticonvulsants, rehabilitation as electro-analgesic currents, and myofascial release. If conservative measures do not adequately control the symptoms, an ultrasound-guided nerve block, hydro-dissection, cryotherapy, or nerve radiofrequency ablation can generally provide satisfactory symptomatic relief. Resistant cases may require a neurectomy.