Nerve-entrapment Syndromes from Lower Abdominal Surgery

Patients with a complaint of lower abdominal pain and a history of lower abdominal surgery, particularly inguinal herniorrhaphy, appendectomy, and procedures incorporating a Pfannenstiel incision, should have nerve entrapment considered in the differential diagnosis. Careful history and physical examination in conjunction with selected use of the ilioinguinal-iliohypogastric nerve block can confirm the diagnosis of nerve entrapment and preclude an unnecessary workup of these patients. Of the patients with nerve entrapment, most will experience complete relief of symptoms following serial injections and require no further treatment. The remainder will experience only temporary relief and require surgical interruption of the nerve involved. In those patients who obtain no relief from the nerve block, further workup for a source of their pain is warranted. Most of these patients were found to have a subclinical recurrence of an inguinal hernia.