Quevedo Orrego Esteban, Robla Costales Javier, Rodríguez Aceves Carlos, Diana Martín Rubén, González Álvarez Adán, Socolovsky Mariano
Neurosurgical Department, Complejo Asistencial Universitario de León, León, Spain.
Neurosurgical Department, HM Hospitales Regla/San Francisco, Calle Cardenal Landázuri 2, 24003, León, Spain.
Childs Nerv Syst. 2021 Jun;37(6):1825-1830. doi: 10.1007/s00381-021-05177-w. Epub 2021 Apr 27.
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 After discharge, analgesic therapy was gradually withdrawn and, ultimately, discontinued altogether.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.
描述文献中首例因腹腔镜阑尾切除术导致医源性神经损伤继发的神经性腹股沟疼痛的儿科病例，详细阐述手术前后的临床和形态学表现。回顾成年患者的相关文献，并讨论病理生理、治疗和预后因素。
一名14岁女性患者有3年前腹腔镜阑尾切除术史。术后3个月，她出现神经性腹股沟疼痛，且逐渐加重，对神经调节剂和多次神经阻滞均无效。鉴于其病情恶化、对保守治疗反应不佳且明确符合慢性术后腹股沟疼痛（CPIP）标准，遂进行手术治疗。
通过原切口进行开放手术，术中证实髂腹下神经（IH）一支受损。对受影响分支进行神经松解术后，患者疼痛明显缓解，痛觉过敏消失，皮肤色素沉着消退。出院后，镇痛治疗逐渐减量，最终完全停用。
对于所有在此区域进行手术的外科医生而言，了解腹股沟区的神经解剖是必不可少的，以避免包括CPIP在内的并发症并优化患者预后。CPIP的手术治疗对于保守治疗失败的患者控制严重疼痛可能有效。需要在儿科人群中开展研究以确定该疾病在青少年中的具体特征。
