Pudendal nerve entrapment leading to avoidant/restrictive food intake disorder (ARFID): A case report.

Avoidant/restrictive food intake disorder (ARFID) is a diagnosis in diagnostic and statistical manual of mental disorders-5 (DSM-5) manifested by persistent failure to meet nutritional and/or energy needs. Pudendal nerve entrapment (PNE) often causes pelvic discomfort in addition to constipation and painful bowel movements. Current literature on ARFID is sparse and focuses on the pediatric and adolescent population. No association between PNE and ARFID has been described. We present a case of ARFID in an adult male with PNE resulting from subsequent scarring from testicular cancer surgery. The patient's gastrointestinal symptoms due to PNE caused significant food avoidance and restriction subsequently leading to severe malnourishment. Clinicians should be aware that distressing gastrointestinal symptoms arising from a secondary disease process such as PNE might lead to dietary restriction and food aversion. More research is needed for proper screening, detection, and treatment of ARFID. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2017; 50:84-87).

Pudendal Neuralgia: A New Option for Treatment? Preliminary Results on Feasibility and Efficacy.

OBJECTIVE: The aim of this prospective study was to investigate the feasibility and report the short-term results of a new procedure for treatment of pudendal neuralgia, consisting of transperineal injections of autologous adipose tissue with stem cells along the Alcock's canal. METHODS: Fifteen women with pudendal neuralgia not responsive to 3-months medical therapy were examined clinically, with VAS score, validated SF-36 questionnaire, and pudendal nerve motor terminal latency (PNMTL). These patients were submitted to pudendal nerve lipofilling. Clinical examinations with VAS, SF36, and PNTML were scheduled during 12 months follow-up, with the incidence of pain recurrence (VAS > 5) as primary outcome measure. Appropriate tests were used for statistics. RESULTS: All patients had preoperative increase of pudendal nerve latencies. Twelve patients completed the follow-up protocol. There was no mortality, and no complications. Two patients had no pain improvement and continued to use analgesic drugs. At 12 months VAS significantly improved (3.2 ± 0.6 vs 8.1 ± 0.9, P < 0.001), as well SF36 (75.5 ± 4.1 vs 85.0 ± 4.5 preoperative, P < 0.01), while PNTML showed a nonsignificant trend to a better nerve conduction (2.64 ± 0.04 vs 2.75 ± 0.03 preoperative, P = 0.06). CONCLUSIONS: The new technique seems to be easy, with low risk of complications, and with significant improvement of symptoms in the short period. A larger study with appropriate controls and longer follow-up is now needed to assess its real effectiveness.