Yigzaw Wassie Almaw, Demissie Werkneh, Kiros Meron, Dagnachew Helina, Tilahun Tazebew, Worku Walelign, Negash Samuel
Department of Surgery, Pediatric Surgery Unit, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia.
Department of Neurology, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia.
J Med Case Rep. 2025 Sep 26;19(1):455. doi: 10.1186/s13256-025-05316-w.
Meralgia paresthetica is a sensory neuropathy resulting from the entrapment or injury of the lateral femoral cutaneous nerve. It presents with sensory symptoms such as numbness, paresthesia, and chronic pain in the anterolateral thigh above the knee. Although it is typically idiopathic, meralgia paresthetica can occasionally occur as a complication of an appendiceal abscess, as observed in our patient.
A 12-year-old Black African male patient presented with abdominal pain lasting for 1 week. The pain initially occurred in the periumbilical area and later localized to the right lower quadrant, accompanied by anorexia, fever, and three episodes of vomiting. He reported numbness in his right thigh during the 3 days preceding his hospital visit. On physical examination, he had a firm, tender, palpable mass in the right lower abdomen. Pain and touch sensations were diminished over the right anterolateral thigh. His white blood cell count was 16,000 per microliter, with a neutrophil percentage of 89%, and ultrasound revealed perforated appendicitis with a sizeable appendicular abscess extending to the right psoas muscle. Given the impression of an appendiceal abscess, under general anesthesia, the patient was explored through a right lower quadrant transverse incision. Intraoperatively, a mass formed between the ileum, cecum, lateral abdominal wall, and omentum that contained approximately 200 cc of thick, intense pus, and extensive necrotic tissue was noted over the psoas bed. The cavity was dismantled, the abscess was drained, and the necrotic tissue was debrided. He had a smooth postoperative course and was discharged in stable condition after a 5-day hospital stay. His sensory symptoms persisted during the postoperative period, although improvement was noted during his second referral clinic visit.
Although meralgia paresthetica typically has iatrogenic causes in surgical patients, it may also arise from primary intra-abdominal or pelvic pathology. Self-limiting lateral femoral cutaneous neuropathy can occur in patients with appendiceal abscess; hence, a high index of suspicion and a thorough examination are essential to identify this uncommon complication of appendiceal abscess. His sensory symptoms began in the preoperative period, which makes iatrogenic causes unlikely.
股外侧皮神经痛是一种感觉神经病变，由股外侧皮神经受压或损伤引起。其表现为感觉症状，如膝盖上方大腿前外侧麻木、感觉异常和慢性疼痛。虽然通常为特发性，但股外侧皮神经痛偶尔也可作为阑尾脓肿的并发症出现，正如我们的患者所观察到的那样。
一名12岁的非洲黑人男性患者出现持续1周的腹痛。疼痛最初发生在脐周区域，随后局限于右下腹，伴有厌食、发热和3次呕吐。他报告在入院前3天右大腿麻木。体格检查时，右下腹可触及一个坚硬、压痛的肿块。右大腿前外侧的痛觉和触觉减退。他的白细胞计数为每微升16,000，中性粒细胞百分比为89%，超声显示阑尾穿孔伴一个较大的阑尾脓肿延伸至右腰大肌。鉴于诊断为阑尾脓肿，在全身麻醉下，通过右下腹横切口对患者进行探查。术中，在回肠、盲肠、侧腹壁和网膜之间形成了一个肿块，其中含有约200毫升浓稠、脓性的脓液，腰大肌床可见广泛的坏死组织。清除脓腔，引流脓肿，并清除坏死组织。他术后恢复顺利，住院5天后病情稳定出院。术后他的感觉症状持续存在，不过在第二次复诊时有所改善。
虽然股外侧皮神经痛在手术患者中通常有医源性原因，但也可能源于原发性腹腔内或盆腔病变。阑尾脓肿患者可能会出现自限性股外侧皮神经病变；因此，高度的怀疑指数和全面的检查对于识别这种阑尾脓肿的罕见并发症至关重要。他的感觉症状在术前就已出现，这使得医源性原因不太可能。
