The iliohypogastric nerve is the motor supply to the lower abdominal wall muscles and the sensory supply to the lower abdomen and lateral hip region. It is vulnerable during lower abdominal incisions (Pfannenstiel, McBurney, inguinal ligament-based incisions) and during iliac crest bone graft harvest. Iliohypogastric neuralgia from injury produces lower abdominal and suprapubic burning pain and skin hypersensitivity.
| Origin | Lumbar plexus (L1, often with a contribution from T12), alongside the ilioinguinal nerve |
|---|---|
| Course | Emerges from the upper lateral border of psoas, crosses anterior to quadratus lumborum behind the kidney, pierces transversus abdominis above the iliac crest, runs between transversus abdominis and internal oblique, and ends as lateral and anterior (hypogastric) cutaneous branches |
| Motor |
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| Sensory |
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The iliohypogastric nerve is at risk in lower abdominal incisions, including Pfannenstiel incisions that extend beyond the lateral border of rectus abdominis, appendicectomy and inguinal incisions, and during iliac crest bone graft harvest. Higher up, it can be injured behind the kidney in flank incisions and retroperitoneal or lateral lumbar spine approaches. Entrapment in scar or sutures causes burning suprapubic or groin pain with skin hypersensitivity. It is blocked with the ilioinguinal nerve medial to the anterior superior iliac spine for inguinal surgery, and nerve block or neurectomy can relieve neuralgia.
Nerve injury during lower abdominal surgery producing suprapubic burning pain and hypersensitivity managed with nerve block or neurectomy.
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