DIVERSE ANATOMICAL CONFIGURATION of ILIOINGUINAL NERVE in RELATION to LATERAL FEMORAL CUTANEOUS NERVE Khizer H
Ilioinguinal and lateral femoral cutaneous nerve Rev Arg de Anat Clin; 2021, 13 (2): 85-88 ______
Case Report
DIVERSE ANATOMICAL CONFIGURATION OF ILIOINGUINAL NERVE IN RELATION TO LATERAL FEMORAL CUTANEOUS NERVE Khizer H. A. Mookane, Azra M. Karnul
Department of Anatomy, MVJ Medical College & Research Hospital, Bangalore, Karnataka, India Department of Anatomy, East Point College of Medical Sciences and Research Centre, Bangalore, Karnataka, India
ABSTRACT INTRODUCTION The variability in the formation of Ilioinguinal nerve has been documented in the literature especially related to The Ilioinguinal nerve (IIN) originates from the iliohypogastric nerve. But so far very few cadaveric ventral ramus of first lumbar nerve. It emerges studies have been documented on variation in the from the lateral border of psoas major, with or branches of ilioinguinal nerve. A case presented which just inferior to the iliohypogastric nerve. It passes demonstrates aberrancy of its anatomic position. obliquely across the broad muscles of abdomen Although the course of ilioinguinal nerve is well known, before piercing the internal oblique muscleand nostudies have documented the variation of its course then traverses the inguinal canal below the in relation to lateral femoral cutaneous nerve. This case report serves as a warning to the surgeon to be spermatic cord (Ndiaye et al., 2010). It emerges aware of such bizarre presentation since the with the cord from the superficial inguinal ring to consequences of iatrogenic injury to such structures supply the proximal medial skin of the thigh and may be serious. the skin over the root of the penis and upper part Keywords: Ilioinguinal nerve, Lumbar plexus, Lateral of the scrotum in males, or the skin covering the femoral cutaneous nerve. mons pubis and the adjoining labium majus in female. Border nerves include the ilioinguinal (IIN), RESUMEN iliohypogastric, and genitofemoral nerves, which supply the skin between the thigh and anterior La variabilidad en la formación del nervio ilioinguinal abdominal wall (Paul and Shastri, 2020).The ha sido documentada en la literature especialmente ilioinguinal nerve and iliohypogastric nerve are relacionada con el nervio iliohipogástrico. Pero hasta ahora se han documentado muy pocos estudios likely to get injured during surgeries like cadavéricos sobre la variación en las ramas del nervio appendectomy, inguinal hernia repair, ilioinguinal. Se presenta un caso que demuestra una retroperitoneal endoscopic surgeries, bone graft aberrancia de su posición anatómica. Aunque el curso harvesting, breech delivery, prolonged lithotomy del nervio ilioinguinal es bien conocido, ningún estudio position in gynaecological procedures like vaginal ha documentado una variación de su curso en relación hysterectomy (Warner et al., 2000; Izci et al., con el nervio cutáneo femoral lateral. Este informe de 2005; Matejcik, 2010). caso sirve como una advertencia al cirujano para que ______esté al tanto de una presentación tan extraña, ya que las consecuencias de la lesion iatrogénica en tales * Correspondence to: Khizer H A Mookane. estructuras pueden ser graves. [email protected] Palabras clave: nervio ilioinguinal, plexo lumbar, Received: 13 May, 2021. Revised: 6 June, 2021. Accepted: nervio cutáneo femoral lateral. 11 June, 2021.
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Ilioinguinal and lateral femoral cutaneous nerve Rev Arg de Anat Clin; 2021, 13 (2): 85-88 ______
This report aims to highlight a rare case of bewaring surgeons to be aware of such bizarre unusual course of ilioinguinal nerve in relation to presentation causing iatrogenic injury to above lateral femoral cutaneous nerve (LFCN), nerves which may have severe consequences.
Figure 1A: Left Ilioinguinal nerve (IIN) crossing over the lateral femoral cutaneous nerve (LFCN). 1B: Diagrammatic representation of the above variation. FN: Femoral Nerve.
CASE REPORT removed in order to visualize the posterior abdominal wall. An unusual case of a variant course of ilioinguinal The psoas muscle was removed piecemeal to nerve (IIN) in relation to lateral femoral cutaneous identify the each branch of lumbar plexus. nerve (LFCN) was detected during a routine Usually theIIN originates from the L1 ventral dissection of a 68 years old formalin fixed, male ramus. It passes obliquely across quadratus cadaver, utilized for dissection class at the lumborum and the upper part of iliacus and Department of Anatomy, MVJ Medical college, enters transverses abdominis near the anterior Hoskote, Bangalore. Following the steps in end of the iliac crest. It pierces internal oblique Cunnigham’s dissection manual, the anterior and supplies it and then traverses the inguinal abdominal was incised. The skin, superficial canal below the spermatic cord. But in the fascia, muscles of anterior abdominal wall, present case,left IIN did not enter the transverse abdominal organs and retroperitoneum were abdominis and directly pierced the internal
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Ilioinguinal and lateral femoral cutaneous nerve Rev Arg de Anat Clin; 2021, 13 (2): 85-88 ______oblique muscle. While traversing in the posterior literature (Figure 1). The rest of the dissection abdominal wall, it crossed the left lateral femoral went smoothly, and the other lumbar plexus cutaneous nerve anteriorlywhich was very unique branches were found to be normal. The right and has not been reported till date in the ilioinguinal nerve showed no variation (Figure 2).
Figure 2: showing the dissection of right side lumbar plexus with no variations.IIN: Ilioinguinal nerve, LFCN: lateral femoral cutaneous nerve, FN: Femoral Nerve.
DISCUSSION 2013) to a large extent, but its intra-abdominal path remains unexplored. Das et al. (2014) recorded a single case of The previous literature descriptions focus mainly variant intra- abdominal course of ilioinguinal on the variations in the formation of lumbar nerve and reported that ilioinguinal nerve plexus branches (Matejcik, 2010; Yasarer al., emerged from the superficial side of the right 2014). The ilioinguinal nerve's path deviation is psoas major muscle which differed from the an uncommon occurrence.Few authors have traditional interpretation of its emergence from documented aberrant courses of the ilioinguinal the lateral side of the above mentioned muscle. nerve throughout its extra-abdominal path that is Normally, the course of LCFN is not related to variation in emergence in the inguinal region and the IIN, but in our case, it was seen crossing its termination (Papadopoulos and Katritsis, anteriorly by the left IIN which has not been 1981; Ndiaye et al., 2010; Pandhare and Gaiwad, reported in previous literature.
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Ilioinguinal and lateral femoral cutaneous nerve Rev Arg de Anat Clin; 2021, 13 (2): 85-88 ______
The most common site of ilioinguinal nerve ACKNOWLEDGEMENT entrapment is observed in paravertebral region, near iliac crest and the lateral border of rectus We sincerely acknowledge the body donors who abdominis. It may also become entrapped in the have selflessly contributed to the resource inguinal area, and patients who undergo material of the Department for teaching and Pfannenstiel incisions or inguinal hernia repairs research. are more likely to have IIN entrapment somewhere between the ASIS and the pubis (Murinova et al., 2016). The ilioinguinal nerve entrapment syndrome is REFERENCES mostly caused by its complex inguinal course. However, owing to its variable intra-abdominal Das SS, Pangtey B, Mishra S. 2014. A variation course, our study discovered a possible cause of in the intra-abdominal course of the ilioinguinal the above mentioned syndrome. The IIN nerve and its clinical implications.OA syndrome is characterised by iliac fossa Anatomy3: 26. neuralgia radiating to the sensitive territory, which Izci Y, Gurkanlar D, Ozan H, Goul E. 2005. The is often associated by paresthesia or altered Morphological Aspects of Lumbar Plexus and feeling in the inguinal region and the area Roots. Turkish Neurosurgery 15: 87-92. supplied by it(Murinova et al., 2016). Likewise Matejcik V. 2010. Anatomical variations of LFCN may get sandwiched between the lumbosacral plexus. Surgical and Radiologic overlying IIN and underlying posterior abdominal Anatomy 32: 409–14. wall and the condition may mimic Meralgia Murinova N, Krashin D, Trescot AM. 2016. Paresthetica. Peripheral nerve entrapments: Clinical To conclude, this case is the first of its kind to diagnosis and management. Peripheral Nerve report a variation in the intra-abdominal course of Entrapments: Clinical Diagnosis and IIN in relation to LFCN. IIN entrapment is one of Management, Springer. the rare differential diagnosis of lower GI and Ndiaye A., Diop M, Ndoye JM, Ndiaye A, Mané L, genitourinary tract pain and therefore one needs Nazarian S, Dia A. 2010. Emergence and to be aware of the possible sites of entrapment. distribution of the ilioinguinal nerve in the This case report will alsoadd academic value to inguinal region: Applications to the ilioinguinal the existing literature for surgeons and anaesthetic block (about 100 dissections). anesthetists performing nerve block. Surgical and Radiologic Anatomy 32: 55–62. Pandhare S, Gaikwad A. 2013. Anatomical Study of Ilioinguinal Nerve and Its Clinical Correlation. Conflict of Interest Int J Cur Res Rev 5: 69. Nil Papadopoulos N, Katritsis ED. 1981. Some observations on the course and relations of the Funding iliohypogastric and ilioinguinal nerves (based on Nil 348 specimens). Anatomischer Anzeiger 149: 357-64. Informed Consent Paul L, Shastri D. 2019. Anatomical Variations in Not Applicable Formation and Branching Pattern of the Femoral Nerve in Iliac Fossa. National Journal Ethical Approval of Clinical Anatomy 8: 57. It was obtained from the ethical committee of the Warner MA, Warner DO, Harper CM, Schroeder institution DR, Maxson PM. 2000. Lower Extremity Neuropathies Associated with Lithotomy Contributions Positions. Anesthesiology 93; 938-80. The authors in this article have made the Yasar S, Kaya S, Temiz Ç, Tehli O, Kural C, Izci following contribution: MKHA: Conceptualization, Y. 2014. Morphological structure and variations Formal analysis, Investigation, Writing / original of lumbar plexus in human fetuses. Clinical draft; AMK: Methodology, Writing / review and Anatomy 27: 383-88. editing.
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