Background & Aims

Lower abdominal – pelvic pain is an enigmatic complex problem, often misdiagnosed. Sometimes, idiopathic. Thorough history and examination of the patient is required with multidisciplinary approach. Many at times, patients are misdiagnosed leading to frustration amongst patients and doctors, wastage of time and resources. Here, we present a case report of a 26 year old women presenting in a gynaecological clinic with chronic lower abdominal pain, misdiagnosed over three years. With this case report, we aim to throw light on the fact that all patients coming with lower abdominal-pelvic pain in a gynaecological clinic doesn’t have to have a gynaecological problem. This awareness and education amongst gynaecologist, general practioners. general surgeons have to be there.

Methods

A women ,26 years of age, came to the gynaecological department with amenorrhoea and lower abdominal pain on right side, radiating to the pelvic region since 5 years. She has one child of 6 years of age with difficult vaginal delivery. She underwent appendicectomy for these complaints of pain 2 years back. On examination, abdomen showed open appendectomy scar, per-speculum and per-vaginal examinations were normal. All hormonal and radiological reports were normal. Six months back she underwent diagnostic laparoscopy for pain, diagnostic hysteroscopy for amenorrhoea. Mild adhesions were present for which adhesiolysis was done, no signs of endometriosis. Hysteroscopy was suggestive of asherman’s syndrome for which adhesiolysis was done. Post-surgery, she had undue pain, for which she required more than normal painkillers. When during follow up visit, she still complained of pain, thorough neurological examination was done. She was found to have ilioinguinal nerve (IIN) hypersensitivity

Results

Patient was relieved of her pain after the IIN block, she has got one cycle of menstruation. Psychologically, she is doing better.

Conclusions

Proper neurological examination could have saved the woman from two unrequired surgeries, and just with a simple solution, relieved her of her pain. Awareness of neurological examination amongst gynaecologist, surgeons, general practioners is required.

References

Alkatout, I., Wedel, T., Pape, J., Possover, M. and Dhanawat, J., 2021. Pelvic nerves–from anatomy and physiology to clinical applications. Translational neuroscience, 12(1), pp.362-378.

Cooke, Carly M. MD; Flaxman, Teresa PhD; Chen, Innie MD FRCSC; Singh, Sukhbir S. MD, FRCSC. Ilioinguinal/iliohypogastric Nerve Blocks as a Treatment for Pelvic Pain in a Gynecologic Population [4R]. Obstetrics & Gynecology 131():p 195S, May 2018

Presenting Author

Juhi Dhanawat

Poster Authors

Juhi Dhanawat

MD

R N Tagore International Institue of cardiac sciences

Lead Author

E-mail

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Abdominal and Pelvic Pain