Disabling pelvic pain following open surgery for rectal prolapse: a case report

Introduction: Iatrogenic inferior hypogastric plexus neuropathy is a well-reported side effect of rectal prolapse surgery. This case report emphasizes the importance of careful evaluation of surgical strategy in pelvic surgery. Case presentation: A 60-year-old Swiss Caucasian woman developed disabling pelvic pain in the right iliac fossa, radiating to the upper posterior side of the right thigh and right labium majus characterized by electric feelings. This followed resection and bilateral rectal fixation to the sacral promontory as treatment for rectal prolapse. Investigations included a multidisciplinary neurological pain evaluation. A computed tomography scan did not reveal any cause. Revision surgery was performed and a foreign body, a thread, was found wrapped around the inferior hypogastric plexus and was removed. Four years later, the patient remains asymptomatic. Conclusion: This case emphasizes the importance of careful identification of the inferior hypogastric plexus during primary pelvic surgery. Introduction Post-operative disabling chronic pelvic pain with sexual dysfunction in women due to iatrogenic inferior hypogastric plexus (IHP) neuropathy is a well-reported side effect of pelvic surgery, described mainly after hysterectomy but also following total mesorectal resection and rectal prolapse operations [1-3]. Case presentation A 60-year-old Swiss Caucasian woman suffering from depression was referred for chronic pelvic pain. Her medical history revealed that a hysterectomy for benign disease had been performed 17 years previously and a laparotomy and surgical repair had been carried out for rectal prolapse two years previously. That procedure included sigmoid resection and bilateral rectal fixation to the sacral promontory with polypropylene thread. Her hospital stay was uneventful but early increasing pain in the right iliac fossa, radiating to the upper posterior side of the right thigh and right labium majus was reported. The pain was characterized by electric feelings that decreased after defecation. She reported dyspareunia but no urinary complaints. One year