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It is also accompanied by autonomic phenomena, sensory impairments and/or muscle weakness.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Its pathophysiology is still unknown; it constitutes a rare pathology, with only 5 cases/100,000 inhabitants/year. When the nerve injury is detectable, it is known as CRPS type 2, which represents only 15% of cases; the remaining 85% is classified as CRPS type 1. The diagnosis is clinical and exclusionary, applying the Budapest criteria of the <span class="elsevierStyleItalic">International Association for the Study of Pain</span> (IASP).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The following is a case of CRPS after gynaecological laparoscopic surgery, which we consider to be of general interest since it is a previously unreported complication.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A 35-year-old nulligravidous female, treated with oral contraceptives and with a history of irritable bowel syndrome and repeated urinary infections, who complained of recurrent episodes of abdominal pain. The general and gynaecological physical examination was normal. In the basic lab tests, no parametric abnormalities were detected, with negative urine tests and pregnancy tests. A transvaginal ultrasound showed an intramural myoma and benign adnexal cysts. Given the persistence of symptoms, a diagnostic laparoscopy was performed in the lithotomy position and under general anaesthesia, with no incidents recorded. Adhesions from the rectosigmoid junction to the left uterosacral ligament and uterine cervix were debrided. At 48<span class="elsevierStyleHsp" style=""></span>h the patient developed continuous pain in the left lower limb, increased local temperature, standing hyperaemia that improved in decubitus, muscle weakness and hyperesthesia. On examination, a proximal and distal 4/5 muscle balance was identified in the left leg, predominantly affecting the flexor-extensor muscles, with normal trophism and muscle tone and indifferent cutaneous plantar reflex.</p><p id="par0020" class="elsevierStylePara elsevierViewall">A Doppler ultrasound of the lower limbs and a thoracoabdominal CT scan ruled out a vascular origin. A <span class="elsevierStyleSup">99m</span>Tc scintigraphy showed a diffuse increase in vascularity in the left leg and an increase in osteogenic activity in the articular structures of the foot and ankle. The electroneurophysiological evaluation recorded a mild affectation of the sympathetic-reflex response in the lower left limb, with sustained latency but decreased amplitude with respect to the contralateral limb.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The clinical diagnosis was a type 2 CRPS, as the existence of a nerve injury was objectively demonstrated. Outpatient physiotherapy, pain relievers, gabapentin and amitriptyline were prescribed. At 3 months, the patient reported improvement in pain and vasoactive phenomena, persisting weakness in the dorsal flexion of the foot 4/5, mild hypoesthesia on the inside of the leg and allodynia in the rest of the affected region.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The aetiology of CRPS is very diverse, with distal radius and tibia fractures and foot and hand surgeries, more frequently associated with periods of immobilization. However, in our literature search, we have not found CRDS described as a complication of gynaecological laparoscopic surgery. Postoperative neuropathies are well known in this type of intervention, with an incidence of 1.9%, which are related to placing the patient in the Trendelenburg position on the operating table, the patient's movements during surgery and placing the surgical ports.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Recently, an American retrospective study confirmed transient neurological disorders in 0.6% after analysing 967 gynaecological laparoscopies, with no reports of CRPS or long-term neurological complications being reported.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> In another type of laparoscopy such as colorectal, a systematic review carried out by Colsa Gutiérrez et al. described brachial plexopathies but did not report lower limb neuropathies or the occurrence of CRPS.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In view of our growing activity as specialist surgical consultants, we would like to highlight that peripheral neuropathies and, specifically, CRDS, constitute a post-surgical complication that is often underestimated and has a torpid progression, prolonging hospital stay and generating a negative impact on both patient recovery and quality of life, so these should always be included in the informed consent. Lastly, the significance of its prevention by proper timing and patient positioning control during the laparoscopic procedure should be underlined.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Molina-Gil J, Fernández-Díaz Á, Caminal-Montero L. Síndrome de dolor regional complejo tras cirugía ginecológica por laparoscopia. Med Clin (Barc). 2020;154:469–470.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical features and pathophysiology of complex regional pain syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. 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Journal Information
Vol. 154. Issue 11.
Pages 469-470 (June 2020)
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Vol. 154. Issue 11.
Pages 469-470 (June 2020)
Letter to the Editor
Complex regional pain syndrome following laparoscopic gynecological surgery
Síndrome de dolor regional complejo tras cirugía ginecológica por laparoscopia
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