Femoral nerve injury following oophorectomy

Abstract

A 46-year-old woman attended the gynaecology clinic complaining of right iliac fossa pain and dyspareunia of 18 months duration. Her symptoms were gradually worsening. She had a history of hysterectomy and left salpingoophorectomy for menorrhagia caused by fibroids. The patient had a body mass index of 29. Bimanual pelvic examination revealed right adnexal fullness which was confirmed on ultrasound scan to be an ovarian cyst. After appropriate counselling a right oophorectomy was planned. The procedure was performed through a transverse suprapubic incision. During the operation the abdominal wall was held apart with a self-retaining retractor. It was not necessary to open the retroperitoneal space because the ovary was lying adherent to the vaginal vault peritoneum. The procedure was uneventful. In the immediate postoperative period she complained of pain in the right anterior and medial aspect of the thigh. She also showed signs of significant intraperitoneal bleed and developed mild haematuria. Repeat exploratory laparotomy was performed to stop haemorrhage. On the fourth postoperative day she fell down when attempting to walk. She described pain and numbness in the right anterior thigh extending from the inguinal crease and distally to the knee and slightly below the knee on the lateral border. Following recovery from surgery a specialist neurological examination showed weakness of right hip flexion and knee extension, absence of the right knee jerk, and anaesthesia over the anterior and medial aspects of the right thigh. A right femoral neuropathy, presumed secondary to the surgical procedure, was diagnosed. Peripheral neurophysiological studies showed acute denervation of the right vastus lateralis with a marked loss of motor units confirming the clinical diagnosis. The patient started physiotherapy and was treated with amitryptiline and tramadol for her pain. After 8 months there was appreciable improvement in her symptoms. She was started on gabapentin and remains under follow up in a pain clinic.

Iatrogenic femoral nerve injuries: analysis of medico-legal issues through a scoping review approach

“…Femoral nerve injury during ovariectomy is also reported and is generally secondary to the improper use of retractors [ 10 , 86 , 87 ]; ]; a case is also reported in which nerve damage was caused by an incorrect trocar insertion procedure during laparoscopic surgery [85 Nevertheless, in gynaecological surgery, bilateral nerve damage is not uncommon [ 136 ].…”