It is sometimes difficult to clinically delineate genitofemoral and ilioinguinal neuralgias because of the overlap in the clinical symptomatology.
Case description
A young male with a past history of transurethral removal of ureteral calculi presented with severe, debilitating neuropathic pain in the groin. He had hyperpathia and allodynia in the distribution of genitofemoral nerve, and hence a clinical diagnosis of genitofemoral neuralgia was made. An ultrasound guided diagnostic block of the genitofemoral nerve with local anesthetic produced only a mild reduction in pain (VAS 2 reduction). A repeat diagnostic block of the ilioinguinal nerve produced complete resolution of pain.
Literature search showed a limited number of case reports of ultrasound guided blocks for genitofemoral neuralgia; and overlap syndromes have been addressed with differential nerve blocks.
Clinical relevance
Our hypothesis is that an aberrant reinnervation from the ilioinguinal to genitofemoral nerve may present with features favoring a genitofemoral neuralgia. In situations where radiofrequency treatment is being considered, such cases may pose a failed intervention if both nerves are not separately targeted.
How to cite this article
Thomas P, Das G. The Diagnostic Dilemma of a Genitofemoral-ilioinguinal Overlap Syndrome. J Recent Adv Pain 2015;1(1):28-30.
Mesh inguinodynia: a new clinical syndrome after inguinal herniorrhaphy? J Am Coll Surg 1998 Nov;187(5):514-518.
The impact of pain on daily activities following open mesh inguinal hernia repair. Hernia 2008;12(2):153-157.
Persistent pain after groin hernia surgery: a qualitative analysis of pain and its consequences for quality of life. Acta Anaesthesiol Scand 2009 Feb;53(2):236-246.
Current trends in the diagnosis and management of post-herniorraphy chronic groin pain. World J Gastrointest Surg 2011 Jun 27;3(6):73-81.
Genitofemoral neuralgia: a review. Clin Anat 2015 Jan;28(1):128-135.
Surgical management of 10 genitofemoral neuralgias at the Louisiana State University Health Sciences Center. Neurosurgery 2005 Feb;56(2):298-303.
Diagnosis and treatment of genitofemoral and ilioinguinal neuralgia. World J Surg 1989;13:586-591.
Radio frequency thermocoagulation of ganglion impar in the management of coccydynia: preliminary results. Turk Neurosurg 2010 Jul;20(3):328-333.
Pain physician 2006 Jul;9(3):261-266.
On the therapeutic viability of peripheral nerve stimulation for ilioinguinal neuralgia: putative mechanisms and possible utility. Pain Pract 2008 Mar-Apr;8(2):138-143.
Management of neuropathic pain: Translating mechanistic advances and evidence-based research into clinical practice. Clin J Pain 2006;22:2-8.
Evidence that gabapentin reduces neuropathic pain by inhibiting the spinal release of glutamate. J Neurochem 2005 Aug;94(4):1131-1139.
Pulsed radiofrequency for the treatment of ilioinguinal neuralgia after inguinal herniorrhaphy. Mt Sinai J Med 2006;73:716-718.
Cryoanalgesic ablation for the treatment of chronic postherniorrhaphy neuropathic pain. Surg Endosc 2003 Feb;17(2):196-200.
Management of medically intractable genitofemoral and ilioingunal neuralgia. Turkish Neurosurg 2013; 23(6):753-757.