DOCSLIB.ORG

JMSCR Vol||06||Issue||12||Page 318-327||December 2018

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
JMSCR Vol||06||Issue||12||Page 318-327||December 2018 JMSCR Vol||06||Issue||12||Page 318-327||December 2018 www.jmscr.igmpublication.org Impact Factor (SJIF): 6.379 Index Copernicus Value: 79.54 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v6i12.50 Routine Ilionguinal and Iliohypogastric Nerve Excision in Lichenstein Hernia Repair - A Prospective Study of 50 Cases Authors Dr Harekrishna Majhi1, Dr Bhupesh Kumar Nayak2 1Associate Professor, Department of General Surgery, VSS IMSAR, Burla 2Senior Resident, Department of General Surgery, VSS IMSAR, Burla Email: [email protected], Contact No.: 9437137230 Abstract Chronic inguinal neuralgia is one of the most significant complications following inguinal hernia repair. Subsequent patient disability can be severe & may often require numerous interventions for treatment. The purpose of the study is to evaluate long term outcomes following nerve excision to nerve preservation when performing lichenstein inguinal hernia repairs. A prospective study of cases with excision of illionguinal & illiohypogastric nerve excision during lichenstein hernia repair with post operative groin repair at 6 month & 1 yrs from May 2015-17 was carried out in the Deptt. of General Surgery, VSSIMSAR, Burla. neuralgia reported for Lichtenstein repair of Introduction inguinal hernias range from 6% to 29%. The No disease of human body, belongs to the probable cause of chronic inguiodynia after province of the surgeon, requires its treatment, a hernioplasty due to entrapment, inflammation, better combination of accurate anatomical ligation, neuroma or fibrotic reactions involving knowledge with surgical skill than hernia in all its ilioinguinal, iliohypogastric & genitial branch of variety. This statement made by SIR Astley genito-femoral nerve. Routine ilioinguinal nerve Cooper, 1804 & really a true aphorism to all & iliohypogastric nerve excision has been hernia surgeons. proposed as a means to avoid the troubling In most of the surgical OPDs, Inguinal hernia is a complication of long term postherniorrhaphy common entity. Indirect Inguinal Hernia or neuralgia. This excision would eliminate the Oblique inguinal hernia is the most common of all above mentioned possibilities. forms of hernia. Insult to the nerves may occur inform of In adult males, 65 % of inguinal hernias are Primary indirect & 55% are right sided. The hernia is Partial / complete division bilateral in 12% of cases. Stretching Chronic inguinal neuralgia is one of the most Crushing significant complications following hernia repair. Electrical damage Incidence of long term (≥ 1 year) postoperative Dr Harekrishna Majhi et al JMSCR Volume 06 Issue 12 December 2018 Page 318 JMSCR Vol||06||Issue||12||Page 318-327||December 2018 Secondary 2. All repair had been performed by one Entrapment surgeon & team. Irritation by an adjacent inflammatory 3. Illioypogastric & illioinguinal were: reaction. identified & excised during operation. Adherence & Cicatricial compression with Post operative Assessment:- mesh Through personal interview & clinical Neuroma formation. examination at 1 month routine post- Usually the primary injury is not operative check-up at our surgery OPD. Appreciated at operation, nor is the etiologic Through telephone at 6 month and at 1 lesion, identifiable with certainty after the year Post-Operatively. neuralgia begins. Residual neuralgia deserves Out Comes evaluated are attention because they may result in severe 1. Chronic Post herniorrhapy groin pain morbidity and may become difficult to manage. a. Mild Pain Occasional pain or discomfort Study Group Does not limit activity During this period 50 patient were eligible for the Return to pre hernia life style study. All were admitted to this hospital for b. Moderate Pain inguinal hernia repair (herniorrhaphy or Prevents return to normal hernioplasty) preoperative activities such as Inclusion Criteria sports & lifting 1. Age 20-80 years. Analgesics rarely being needed 2. Males c. Severe Pain Exclusion Criteria Incapacitating I. Recurrent hernia Interferes with activity of daily II. Irreducible/ Strangulated hernia living III. Patients with Frequent need of analgesics Previous h/o stroke 2. Paresthesia (Numness) as told by the Peripheral neuropathy patients. Neuromuscular diseases. In this present study patients Were not aware of Diabetes mellitus excision of ilioinguinal nerve & illiohypogastric As from such patients no definite conclusion nerve. about pain or paresthesia can be made. Evolution of Hernia Surgery IV. Patients having Pre-operative inguinal The earlier record of inguinal hernia dates back to neuralgia. approximately 1500 BC. The ancient Greeks were All the patients were divided in to 2 groups based well aware of inguinal hernias & the term derives on routine excision of ilioinguinal nerve & from the Greek word, meaning an offshoot a illiohypogastic (Group – A) & preservation of building or bulge. ilioinguinal & illiohypogastic. The Latin word ‘hernia’ means a rupture or tear. In the earlier part of first century AD, Celus Principles Followed During the study described the operation in vogue at that time in the 1. All patients received the standard Greco-Roman area. technique of hernia repair i.e. Little information was added to the literature until Lichtenstein’s tension free hernioplasty the beginning of 18th century. From this time until using polypropelene mesh. the 19th century anatomy of inguinal region was described & accurately defined. Dr Harekrishna Majhi et al JMSCR Volume 06 Issue 12 December 2018 Page 319 JMSCR Vol||06||Issue||12||Page 318-327||December 2018 Irving Lichtenstein (Born 1920) Technique of the Operation Lichtenstein received his medical education & 1. Exploration of Inguinal Canal surgical training at Hahnemann Medical School. 2. Indirect Hernia Sac– separated from the He is a Diploma of the American Board of cord up to neck and inverted into the Surgery (1950) & became a fellow of the abdomen without excision, suture or American College of Surgeons in 1952. ligature. Lichtenstein is the founder & director of the 3. Direct Hernia Sac – if large inverted by Lichtenstein Hernia Institute in Los Angles. means of a single absorbable invaginating Lichtenstein Tension- free Hernioplasty suture. Since the first true herniorrhaphy was performed 4. Monofilament Polypropelene Mesh is by Bassini over 100 year ago, all modifications & Used:- surgical techniques have shared a common Size 8 x 16 cm/5 x 10 cm disadvantages: suture line tension. The anatomic, Surface texture promotes fibroplasias physiologic & pathologic characteristics of hernia Monofilament structure does not recurrence are examined. The prime etiologic perpetuate or harbor infection. factor behind most hernigraphy failure is the Elicit little tissue reaction. suturing together, under tension of structure that is They are not rejected even in the not normally in opposition. presence of infection. With the use of modern mesh prosthetics, it is Fixation of Mesh now possible to repair all hernia without distortion Medical end of mesh made rounded to the of the normal and with no suture line tension. The shape of medical corner of inguinal Canal. technique is simple, rapid, less painful and First Stitch – Rounded corner is sutured with effective. Allowing prompt resumption of polypropelene (1-0) to the aponeurotic tissue unrestricted physical activity with the prosthesis over the pubic bone (periosteum of the bone for the repair of inguinal hernia in mind and is avoided). The mesh should overlap the focusing on the principal of “no tension” bone by 1 to 1.5 cm because failure to cover (considered one of the great principals of surgery this bone can result in recurrence. by Halsted), the Lichtenstein group popularized The Lower Edge is tacked in place by a routine use of mesh in 1984 and coined the term continuous suture to the inguinal ligament up “tension – free hernioplasty”. to a point just lateral to the internal ring. Main Principles in Lichtenstein Repair Suturing the mesh beyond this is unnecessary In the tension free hernioplasty instead of and could injure the femoral nerve. suturing anatomic structures that are not in A slit is made at the lateral end of mesh apposition (conjoint tendon & inguinal creating two tails, a wide one (2/3) above and ligament), the entire inguinal floor is narrower (1/3) below. The cord is placed reinforced by insertion of a sheet of mesh. between two tails near internal ring. The prosthesis, which is placed between the The superior edge of the mesh is loosely transversalis fascia & the external oblique secured by similar continuous suture aponeurosis extend well beyond the (interrupted in our Institution) to the rectus Hesselbach’s triangle to provide sufficient sheath & conjoined muscle & tendon above. mesh/issue interface. The wider upper tail is crossed & placed over On increased intra abdominal pressure the the narrower one. A single polypropelene external oblique aponeurosis applies counter suture approximates the tail of mesh to pressure on the mesh thus using the intra inguinal ligament lateral to the internal rings. abdominal pressure as a positive factor. Dr Harekrishna Majhi et al JMSCR Volume 06 Issue 12 December 2018 Page 320 JMSCR Vol||06||Issue||12||Page 318-327||December 2018 This creates a new internal ring made of Anterior Wall mesh. 1. External oblique muscle Outcomes of the Operation 2. Internal oblique muscle 1. Post– operative pain: less than other Posterior Wall procedure. 1. Aponeurosis of transverses abdominis 2. Chronic
Load more

Recommended publications
  • Pelvic Anatomyanatomy
    PelvicPelvic AnatomyAnatomy RobertRobert E.E. Gutman,Gutman, MDMD ObjectivesObjectives UnderstandUnderstand pelvicpelvic anatomyanatomy Organs and structures of the female pelvis Vascular Supply Neurologic supply Pelvic and retroperitoneal contents and spaces Bony structures Connective tissue (fascia, ligaments) Pelvic floor and abdominal musculature DescribeDescribe functionalfunctional anatomyanatomy andand relevantrelevant pathophysiologypathophysiology Pelvic support Urinary continence Fecal continence AbdominalAbdominal WallWall RectusRectus FasciaFascia LayersLayers WhatWhat areare thethe layerslayers ofof thethe rectusrectus fasciafascia AboveAbove thethe arcuatearcuate line?line? BelowBelow thethe arcuatearcuate line?line? MedianMedial umbilicalumbilical fold Lateralligaments umbilical & folds folds BonyBony AnatomyAnatomy andand LigamentsLigaments BonyBony PelvisPelvis TheThe bonybony pelvispelvis isis comprisedcomprised ofof 22 innominateinnominate bones,bones, thethe sacrum,sacrum, andand thethe coccyx.coccyx. WhatWhat 33 piecespieces fusefuse toto makemake thethe InnominateInnominate bone?bone? PubisPubis IschiumIschium IliumIlium ClinicalClinical PelvimetryPelvimetry WhichWhich measurementsmeasurements thatthat cancan bebe mademade onon exam?exam? InletInlet DiagonalDiagonal ConjugateConjugate MidplaneMidplane InterspinousInterspinous diameterdiameter OutletOutlet TransverseTransverse diameterdiameter ((intertuberousintertuberous)) andand APAP diameterdiameter ((symphysissymphysis toto coccyx)coccyx)
    [Show full text]
  • The Spinal Nerves That Constitute the Plexus Lumbosacrales of Porcupines (Hystrix Cristata)
    Original Paper Veterinarni Medicina, 54, 2009 (4): 194–197 The spinal nerves that constitute the plexus lumbosacrales of porcupines (Hystrix cristata) A. Aydin, G. Dinc, S. Yilmaz Faculty of Veterinary Medicine, Firat University, Elazig, Turkey ABSTRACT: In this study, the spinal nerves that constitute the plexus lumbosacrales of porcupines (Hystrix cristata) were investigated. Four porcupines (two males and two females) were used in this work. Animals were appropriately dissected and the spinal nerves that constitute the plexus lumbosacrales were examined. It was found that the plexus lumbosacrales of the porcupines was formed by whole rami ventralis of L1, L2, L3, L4, S1 and a fine branch from T15 and S2. The rami ventralis of T15 and S2 were divided into two branches. The caudal branch of T15 and cranial branch of S2 contributed to the plexus lumbosacrales. At the last part of the plexus lumbosacrales, a thick branch was formed by contributions from the whole of L4 and S1, and a branch from each of L3 and S2. This root gives rise to the nerve branches which are disseminated to the posterior legs (caudal glu- teal nerve, caudal cutaneous femoral nerve, ischiadic nerve). Thus, the origins of spinal nerves that constitute the plexus lumbosacrales of porcupine differ from rodantia and other mammals. Keywords: lumbosacral plexus; nerves; posterior legs; porcupines (Hystrix cristata) List of abbreviations M = musculus, T = thoracal, L = lumbal, S = sacral, Ca = caudal The porcupine is a member of the Hystricidae fam- were opened by an incision made along the linea ily, a small group of rodentia (Karol, 1963; Weichert, alba and a dissection of the muscles.
    [Show full text]
  • Study of Anatomical Pattern of Lumbar Plexus in Human (Cadaveric Study)
    54 Az. J. Pharm Sci. Vol. 54, September, 2016. STUDY OF ANATOMICAL PATTERN OF LUMBAR PLEXUS IN HUMAN (CADAVERIC STUDY) BY Prof. Gamal S Desouki, prof. Maged S Alansary,dr Ahmed K Elbana and Mohammad H Mandor FROM Professor Anatomy and Embryology Faculty of Medicine - Al-Azhar University professor of anesthesia Faculty of Medicine - Al-Azhar University Anatomy and Embryology Faculty of Medicine - Al-Azhar University Department of Anatomy and Embryology Faculty of Medicine of Al-Azhar University, Cairo Abstract The lumbar plexus is situated within the substance of the posterior part of psoas major muscle. It is formed by the ventral rami of the frist three nerves and greater part of the fourth lumbar nerve with or without a contribution from the ventral ramus of last thoracic nerve. The pattern of formation of lumbar plexus is altered if the plexus is prefixed (if the third lumbar is the lowest nerve which enters the lumbar plexus) or postfixed (if there is contribution from the 5th lumbar nerve). The branches of the lumbar plexus may be injured during lumbar plexus block and certain surgical procedures, particularly in the lower abdominal region (appendectomy, inguinal hernia repair, iliac crest bone graft harvesting and gynecologic procedures through transverse incisions). Thus, a better knowledge of the regional anatomy and its variations is essential for preventing the lesions of the branches of the lumbar plexus. Key Words: Anatomical variations, Lumbar plexus. Introduction The lumbar plexus formed by the ventral rami of the upper three nerves and most of the fourth lumbar nerve with or without a contribution from the ventral ramous of last thoracic nerve.
    [Show full text]
  • Posterior Approach to Kidney Dissection: an Old Surgical Approach for Integrated Medical Curricula Frank J
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by University of New England University of New England DUNE: DigitalUNE Biomedical Sciences Faculty Publications Biomedical Sciences Faculty Works 2-16-2015 Posterior Approach To Kidney Dissection: An Old Surgical Approach For Integrated Medical Curricula Frank J. Daly University of New England, [email protected] David L. Bolender Medical College of Wisconsin Deepali Jain Michigan State University Sheryl Uyeda SUNY Upstate Medical University Todd M. Hoagland Medical College of Wisconsin Follow this and additional works at: http://dune.une.edu/biomed_facpubs Part of the Endocrine System Commons, and the Urogenital System Commons Recommended Citation Daly, Frank J.; Bolender, David L.; Jain, Deepali; Uyeda, Sheryl; and Hoagland, Todd M., "Posterior Approach To Kidney Dissection: An Old Surgical Approach For Integrated Medical Curricula" (2015). Biomedical Sciences Faculty Publications. 6. http://dune.une.edu/biomed_facpubs/6 This Article is brought to you for free and open access by the Biomedical Sciences Faculty Works at DUNE: DigitalUNE. It has been accepted for inclusion in Biomedical Sciences Faculty Publications by an authorized administrator of DUNE: DigitalUNE. For more information, please contact [email protected]. Posterior Approach to Kidney Dissection 1 ASE-14-0094.R1 Descriptive article Posterior Approach to Kidney Dissection: An Old Surgical Approach for Integrated Medical Curricula Frank J. Daly1*, David L. Bolender2, Deepali Jain3, Sheryl Uyeda4, Todd M. Hoagland2 1Department of Biomedical Sciences, University of New England College of Osteopathic Medicine, Biddeford, Maine 2Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin 3Department of Surgery, Grand Rapids Educational Partners, Michigan State University College of Human Medicine, Grand Rapids, Michigan.
    [Show full text]
  • Cutaneous Nerve Stimulation and Motoneuronal Excitability. II: Evidence for Non-Segmental Influences
    Journal of Neurology, Neurosurgery, and Psychiatry 1984;47: 190-196 Cutaneous nerve stimulation and motoneuronal excitability. II: evidence for non-segmental influences PJ DELWAIDE, P CRENNA* From the Section ofNeurology and Clinical Neurophysiology University of Liege, Liege, Belgium SUMMARY After stimulation of a sensory nerve, even distant motor nuclei undergo excitability changes which are evidenced by recovery curves. In all, two unequal peaks of facilitation can be identified. They appear when a given motor nucleus is tested after stimulation of various sensory nerves or when the same stimulation (of the sural nerve) is studied in various motor nuclei. The first facilitation is seen earlier in the masseter, then in the arm muscles and finally in lower limb muscles. The existence of a supraspinal centre activated by low threshold exteroceptive afferents and facilitating motor nuclei in a rostro-caudal sequence is postulated to account for certain features of the first and second peaks of facilitation. In an earlier publication, we' described excitability sural nerve stimulation on various motor nuclei changes in soleus and tibialis anterior motoneurons located along the length of the neuraxis: soleus, following stimulation of the sural nerve at different quadriceps, short biceps, biceps brachii and masse- intensities. A stimulus intensity which elicits tactile ter. sensation (2.5 x perception threshold) increased the amplitude of test monosynaptic soleus reflexes over Subjects and Methods two successive periods, from 55 to 90 ms (Fa) and from 130 to 170 ms (Fb). Similar results were Seventeen normal volunteers of both sexes were studied, obtained when the sural nerve contralateral to the some of them several times; they were aged between 18 test reflex was stimulated.
    [Show full text]
  • Intercostal, Ilioinguinal, and Iliohypogastric Nerve Transfers for Lower Limb Reinnervation After Spinal Cord Injury: an Anatomical Feasibility and Experimental Study
    LABORATORY INVESTIGATION J Neurosurg Spine 30:268–278, 2019 Intercostal, ilioinguinal, and iliohypogastric nerve transfers for lower limb reinnervation after spinal cord injury: an anatomical feasibility and experimental study *Ahmed A. Toreih, MD,1 Asser A. Sallam, MD, PhD,1 Cherif M. Ibrahim, MD,2 Ahmed I. Maaty, MD,3 and Mohsen M. Hassan4 Departments of 1Orthopedic Surgery and Trauma and 3Physical Medicine, Rheumatology, and Rehabilitation, Suez Canal University Hospitals; 2Department of Anatomy, Suez Canal University; and 4Department of Surgery, Anesthesiology, and Radiology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt OBJECTIVE Spinal cord injury (SCI) has been investigated in various animal studies. One promising therapeutic ap- proach involves the transfer of peripheral nerves originating above the level of injury into those originating below the level of injury. The purpose of the present study was to evaluate the feasibility of nerve transfers for reinnervation of lower limbs in patients suffering SCI to restore some hip and knee functions, enabling them to independently stand or even step forward with assistive devices and thus improve their quality of life. METHODS The feasibility of transferring intercostal to gluteal nerves and the ilioinguinal and iliohypogastric nerves to femoral nerves was assessed in 5 cadavers. Then, lumbar cord hemitransection was performed below L1 in 20 dogs, followed by transfer of the 10th, 11th, and 12th intercostal and subcostal nerves to gluteal nerves and the ilioinguinal and iliohypogastric nerves to the femoral nerve in only 10 dogs (NT group). At 6 months, clinical and electrophysiological evaluations of the recipient nerves and their motor targets were performed.
    [Show full text]
  • Nerves of the Lower Limb
    Examination Methods in Rehabilitation (26.10.2020) Nerves of the Lower Limb Mgr. Veronika Mrkvicová (physiotherapist) Nerves of the Lower Limb • The Lumbar Plexus - Iliohypogastricus nerve - Ilioinguinalis nerve - Lateral Cutaneous Femoral nerve - Obturator nerve - Femoral nerve • The Sacral Plexus - Sciatic nerve - Tibial nerve - Common Peroneal nerve Spinal Nerves The Lumbar Plexus The Lumbar Plexus • a nervous plexus in the lumbar region of the body which forms part of the lumbosacral plexus • it is formed by the divisions of the four lumbar nerves (L1- L4) and from contributions of the subcostal nerve (T12) • additionally, the ventral rami of the fourth lumbar nerve pass communicating branches, the lumbosacral trunk, to the sacral plexus • the nerves of the lumbar plexus pass in front of the hip joint and mainly support the anterior part of the thigh The Lumbar Plexus • it is formed lateral to the intervertebral foramina and passes through psoas major • its smaller motor branches are distributed directly to psoas major • while the larger branches leave the muscle at various sites to run obliquely downward through the pelvic area to leave the pelvis under the inguinal ligament • with the exception of the obturator nerve which exits the pelvis through the obturator foramen The Iliohypogastric Nerve • it runs anterior to the psoas major on its proximal lateral border to run laterally and obliquely on the anterior side of quadratus lumborum • lateral to this muscle, it pierces the transversus abdominis to run above the iliac crest between that muscle and abdominal internal oblique • it gives off several motor branches to these muscles and a sensory branch to the skin of the lateral hip • its terminal branch then runs parallel to the inguinal ligament to exit the aponeurosis of the abdominal external oblique above the external inguinal ring where it supplies the skin above the inguinal ligament (i.e.
    [Show full text]
  • A STUDY of VARIATIONS in ILIOHYPOGASTRIC and ILIOINGUINAL NERVES in HUMAN ADULTS Premalatha Gogi
    International Journal of Anatomy and Research, Int J Anat Res 2019, Vol 7(3.1):6727-31. ISSN 2321-4287 Original Research Article DOI: https://dx.doi.org/10.16965/ijar.2019.209 A STUDY OF VARIATIONS IN ILIOHYPOGASTRIC AND ILIOINGUINAL NERVES IN HUMAN ADULTS Premalatha Gogi. Assistant professor, Department of anatomy, Mysore Medical College, Mysore, Karnataka, India. ABSTRACT Introduction: Lumbar plexus is one of the main nervous pathways supplying the lower limb which is bound to show variations. Surgeons should be aware of these variations to avoid possible injuries to the structure and their consequences. This study was conducted to observe the formation of Iliohypogastric nerve and Ilioinguinal nerve Material and methods: Dissection of 40 bilateral lumbar plexuses from formalin fixed adult human cadavers procured from department of anatomy JJMMC Davangere. Results: Many significant variations were found in the anatomy of the iliohypogastric and ilioinguinal nerve. Conclusion: Knowledge of the variations in the branching pattern and formation of the lumbar plexus is essential to prevent nerve injury during routine surgical procedures like inguinal hernia surgery, low transverse incision of gynecological procedures. KEY WORDS: Anatomical Variations, Ilioinguinal nerve, Iliohypogastric nerve, lumbar plexus. Address for Correspondence: Dr Premalatha Gogi, Assistant professor, Department of anatomy, Mysore Medical College, Mysore, Karnataka, India. Phone No:9448829619 E-Mail: [email protected] Access this Article online Journal Information
    [Show full text]
  • Download Article (PDF)
    CASE REPORT Osteopathic Approach to the Treatment of a Patient With Idiopathic Iliohypogastric Neuralgia David B. Fuller, DO From the Department of Iliohypogastric neuralgia is an uncommon etiology of lower abdominal pain Osteopathic Manipulative caused by entrapment of the iliohypogastric nerve. Conventional manage- Medicine at Philadelphia College of Osteopathic ment consists of medications, injections, and surgery; previous literature Medicine in Pennsylvania. has not explored the use of osteopathic manipulative medicine for manage- Financial Disclosures: None ment of iliohypogastric neuralgia. Here, the author discusses the case of a reported. 72-year-old woman who presented with 2 years of right lower abdominal Support: None reported. pain, having failed multiple treatments, including exploratory laparoscopy Address correspondence to and appendectomy. Following management of the patient’s somatic dysfunc- David B. Fuller, DO, tions with osteopathic manipulative treatment and a heel lift, her iliohypogas- 2075 Paper Mill Road, Huntingdon Valley, tric neuralgia was significantly improved. PA 19006-5815. J Am Osteopath Assoc. 2020;120(12):907-912. Published online October 21, 2020. doi:10.7556/jaoa.2020.150 Email: [email protected] Keywords: abdominal pain, iliohypogastric neuralgia, OMM, OMT, osteopathic manipulative treatment, short leg Submitted syndrome May 27, 2020; revision received July 1, 2020; accepted July 14, 2020. diopathic iliohypogastric neuralgia is an uncommon and often underrecognized cause of lower abdominal pain.1,2
    [Show full text]
  • 19408-Unusual-Origin-Of-The-Anterior-Scrotal-Nerve-A-Case-Report.Pdf
    Open Access Case Report DOI: 10.7759/cureus.4557 Unusual Origin of the Anterior Scrotal Nerve: A Case Report Karishma Mehta 1 , Joe Iwanaga 2 , R. Shane Tubbs 3 1. Clinical Anatomy, Seattle Science Foundation, Seattle, USA 2. Medical Education and Simulation, Seattle Science Foundation, Seattle, USA 3. Neurosurgery, Seattle Science Foundation, Seattle, USA Corresponding author: Joe Iwanaga, [email protected] Abstract The anterior scrotal nerve is a cutaneous nerve that branches from the ilioinguinal nerve after it leaves the superficial inguinal ring. However, we identified a cadaveric specimen with an anterior scrotal nerve arising from both the femoral and ilioinguinal nerves. This anatomic variation should be considered with anesthetic blockade of this region or during surgical procedures nearby. Categories: Other Keywords: scrotum, femoral nerve, ilioinguinal nerve, anatomy, cadaver Introduction The anterior scrotal nerve provides cutaneous innervation to a portion of the penis and the upper scrotum in males. It arises from the ilioinguinal nerve after the aforementioned nerve passes through the superficial inguinal ring [1]. Both the ilioinguinal and femoral nerves originate from the lumbar plexus via ventral rami of L1 and L2-4, respectively. Normally, the femoral nerve gives rise to two cutaneous branches, anterior femoral nerves, and the saphenous nerve [2-3]. Herein, we report a case in which the anterior scrotal nerve arose from both the ilioinguinal and femoral nerves. Case Presentation During routine dissection of the thigh, a variant anterior scrotal branch was found in an African-American fresh-frozen male cadaver whose age at death was 79-years-old. The anterior division of the femoral nerve gave rise to two cutaneous nerves, the medial femoral cutaneous nerve of the thigh (MFC) and the intermediate cutaneous nerve of the thigh (ICN).
    [Show full text]
  • MORPHOLOGY of LUMBAR PLEXUS and ITS CLINICAL SIGNIFICANCE Deepti Arora *1, Shyam Sunder Trehan 2, Subhash Kaushal 3, Usha Chhabra 4
    International Journal of Anatomy and Research, Int J Anat Res 2016, Vol 4(1):2007-14. ISSN 2321-4287 Original Research Article DOI: http://dx.doi.org/10.16965/ijar.2016.131 MORPHOLOGY OF LUMBAR PLEXUS AND ITS CLINICAL SIGNIFICANCE Deepti Arora *1, Shyam Sunder Trehan 2, Subhash Kaushal 3, Usha Chhabra 4. *1 Assistant Professor, Department of Anatomy, MMIMSR, Mullana, Ambala, Haryana, India. 2 Assistant Professor, Department of Surgical oncology, MMIMSR, Mullana, Ambala, Haryana, India. 3 Professor and former Head of Department, Department of Anatomy, GMC, Patiala, Punjab, India. 4 Professor and former Head of Department , Department of Anatomy, GMC Patiala, Punjab, India. ABSTRACT Background and Objectives: Looking to the applied significance of lumbar plexus in the form of its involvement in various injuries and entrapment, it is imperative to have a thorough knowledge about its formation, branching pattern and variations. Materials and Methods: The study was performed on 30 formalin embalmed cadavers in the department of anatomy, Government Medical College, Patiala. The muscles of the posterior abdominal wall were exposed. The fibers of psoas major muscle were dissected from the transverse processes of lumbar vertebrae and the nerves of lumbar plexus were exposed. Results: The variable origin of iliohypogastric nerve was found in 8.33% cases. It was not found in 8 specimens. Ilioinguinal nerve was not seen in 14.97% cases. Variations in morphological origin of genitofemoral nerve were seen in 13.36% cases and in case of femoral nerve , variations were in 43.32% cases. Lateral femoral cutaneous nerve was seen arising from femoral nerve in 8.33% cases and was not found in 16.67% cases.
    [Show full text]
  • Anatomy Flashcards: Ventral Trunk
    ANATOMY FLASHCARDS Ventral trunk Dear Anatomy Geek, Welcome to your Kenhub flashcards eBook. This eBook is laid out in a flashcard style format, which means that you can learn anatomy easily and on the go. Oh- and without having to deal with a tidal wave of handmade flashcards flying around. Result! So, how do I use this anatomy eBook? It couldn’t be simpler. On the first page, you will see an illustration of an anatomical structure along with a question asking you to identify it. Allow yourself a few seconds to recall the name of the structure you see as well as its purpose in the body. Once you think you’ve got it, flip the page. Here you will see the answer in English and Latin, as well as some additional information about the structure. It’s important to be honest with yourself. Did you get it right? If so, great! Move onto the next card. If not, make a note to come back to it later before you move onto the next card. And that’s it! It’s really that easy. Swipe the page to get started now. QUESTION What structure is shown here? Image by: Yousun Koh ENGLISH Subclavius muscle LATIN Musculus subclavius ORIGINS First rib INSERTIONS Clavicle INNERVATIONS Subclavian nerve FUNCTIONS Stabilizes the clavicle Image by: Yousun Koh QUESTION What structure is shown here? Image by: Samantha Zimmerman ENGLISH Trapezoid line LATIN Linea trapezoidea Image by: Samantha Zimmerman QUESTION What structure is shown here? Image by: Yousun Koh ENGLISH Anterior intercostal arteries LATIN Arteriae intercostales anteriores Image by: Yousun Koh QUESTION What
    [Show full text]