[MO-50] Presentation Awards
Genitofemoral neuralgia secondary to haematoma post-femoral angioplasty
Femoral angiogram is a common procedure for diagnostic and therapeutic purposes. We report a case of genitofemoral neuralgia following femoral angiogram which was complicated by a large groin haematoma, a novel complication of the procedure and review the literature surrounding this phenomenon.
A 75 year old lady underwent angiography of the right lower limb for treatment of intermittent claudication. Accessing the superficial femoral artery (SFA) was difficult, several attempts were undertaken prior to abandoning the right side, eventually establishing access with an up and over approach via the left common femoral artery. The procedure was accomplished without further complication but post-operatively a haematoma formed in the right groin. This was managed conservatively, and the patient was discharged on the first post-operative day with analgesia.
The patient represented to the Emergency Department 3 weeks later with escalating pain in the upper thigh and groin, with significant mechanical and temperature allodynia over the distribution of the femoral branch of the right genitofemoral nerve. All alternate pathologies such as ongoing haematoma, pseudoaneurysm and hernia were excluded by examination and imaging. She was eventually diagnosed with genitofemoral neuralgia.
Genitofemoral neuralgia is most commonly secondary to iatrogenic causes; predominantly found after inguinal hernia repair, both open and laparoscopic. There have also been cases reported in association with caesarean section, lymph node biopsy, hysterectomy, vasectomy and historically with open appendicectomy. In light of the increasing use of angiogram, it is importance to recognise and report novel complications to broaden our awareness of rare & unusual events.
A 75 year old lady underwent angiography of the right lower limb for treatment of intermittent claudication. Accessing the superficial femoral artery (SFA) was difficult, several attempts were undertaken prior to abandoning the right side, eventually establishing access with an up and over approach via the left common femoral artery. The procedure was accomplished without further complication but post-operatively a haematoma formed in the right groin. This was managed conservatively, and the patient was discharged on the first post-operative day with analgesia.
The patient represented to the Emergency Department 3 weeks later with escalating pain in the upper thigh and groin, with significant mechanical and temperature allodynia over the distribution of the femoral branch of the right genitofemoral nerve. All alternate pathologies such as ongoing haematoma, pseudoaneurysm and hernia were excluded by examination and imaging. She was eventually diagnosed with genitofemoral neuralgia.
Genitofemoral neuralgia is most commonly secondary to iatrogenic causes; predominantly found after inguinal hernia repair, both open and laparoscopic. There have also been cases reported in association with caesarean section, lymph node biopsy, hysterectomy, vasectomy and historically with open appendicectomy. In light of the increasing use of angiogram, it is importance to recognise and report novel complications to broaden our awareness of rare & unusual events.