Which criteria are used to diagnose iliohypogastric nerve entrapment and what conditions should be included in the differential diagnoses?

Updated: Oct 15, 2019
  • Author: Minoo Hadjari Hollis, MD; Chief Editor: Thomas M DeBerardino, MD  more...
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Answer

The following three major criteria are used to diagnose iliohypogastric nerve entrapment:

  • History of a surgical procedure in the lower abdominal area (though spontaneous entrapment can occur) - Pain can usually be elicited by palpating laterally about the scar margin, and the pain usually radiates inferomedially toward the inguinal region and into the suprapubic and proximal genital area
  • A definite area of hypoesthesia or hyperesthesia identified in the region of supply of the iliohypogastric nerve
  • Symptoms relieved by local anesthesia - Infiltration of a local anesthetic into the region where the iliohypogastric and ilioinguinal nerves depart the internal oblique muscle and where symptoms can be reproduced on physical examination by palpation should provide symptomatic relief

If no relief is obtained with injection, a different cause of the discomfort should be sought. Alternate diagnoses include upper lumbar or lower thoracic nerve root pathology and pain of discogenic origin. If the iliohypogastric nerve is clearly identified as the source of pain and a favorable response is not obtained with local anesthetic injection, then surgical exploration and resection of the nerve should be considered.


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