Ultrasound-Guided Diagnosis and Treatment of Postsurgical Peripheral Nerve Entrapment in Persistent Pelvic Pain

Postsurgical peripheral neuropathic pain may be overlooked in patients with chronic pelvic and inguinal pain when overlapping etiologies coexist. This case report describes an ultrasound-guided diagnostic and therapeutic approach for suspected postsurgical neuropathic pain after cosmetic abdominal surgery with persistent pain refractory to conventional pelvic surgical treatments (pelvic veins embolization and endometriosis surgery). A patient with chronic pelvic and inguinal pain underwent focused neuropathic clinical assessment and ultrasound evaluation. Targeted ultrasound identified focal thickening of a superficial nerve in the inguinal region consistent with the genitofemoral nerve. Two reproducible low-volume diagnostic blocks produced complete but temporary pain relief. A stepwise perineural treatment strategy, including hydrodissection and pulsed radiofrequency neuromodulation, was subsequently performed, resulting in sustained pain reduction, functional improvement, and reduced analgesic requirements at three- and six-month follow-ups. This case highlights the potential value of focused neuropathic assessment, ultrasound localization, and diagnostic nerve blocks in selected patients with persistent pelvic and inguinal pain after abdominal surgery. In this setting, ultrasound may also aid in establishing a rapid and precise diagnosis while facilitating minimally invasive, targeted image-guided therapies.