Appendiceal abscess presenting with meralgia paresthetica: a case report and review of literature

Meralgia paresthetica is a sensory neuropathy resulting from the entrapment or injury of the lateral femoral cutaneous nerve. It presents with sensory symptoms such as numbness, paresthesia, and chronic pain in the anterolateral thigh above the knee. Although it is typically idiopathic, meralgia paresthetica can occasionally occur as a complication of an appendiceal abscess, as observed in our patient.

A 12-year-old Black African male patient presented with abdominal pain lasting for 1 week. The pain initially occurred in the periumbilical area and later localized to the right lower quadrant, accompanied by anorexia, fever, and three episodes of vomiting. He reported numbness in his right thigh during the 3 days preceding his hospital visit. On physical examination, he had a firm, tender, palpable mass in the right lower abdomen. Pain and touch sensations were diminished over the right anterolateral thigh. His white blood cell count was 16,000 per microliter, with a neutrophil percentage of 89%, and ultrasound revealed perforated appendicitis with a sizeable appendicular abscess extending to the right psoas muscle. Given the impression of an appendiceal abscess, under general anesthesia, the patient was explored through a right lower quadrant transverse incision. Intraoperatively, a mass formed between the ileum, cecum, lateral abdominal wall, and omentum that contained approximately 200 cc of thick, intense pus, and extensive necrotic tissue was noted over the psoas bed. The cavity was dismantled, the abscess was drained, and the necrotic tissue was debrided. He had a smooth postoperative course and was discharged in stable condition after a 5-day hospital stay. His sensory symptoms persisted during the postoperative period, although improvement was noted during his second referral clinic visit.

Although meralgia paresthetica typically has iatrogenic causes in surgical patients, it may also arise from primary intra-abdominal or pelvic pathology. Self-limiting lateral femoral cutaneous neuropathy can occur in patients with appendiceal abscess; hence, a high index of suspicion and a thorough examination are essential to identify this uncommon complication of appendiceal abscess. His sensory symptoms began in the preoperative period, which makes iatrogenic causes unlikely.