A patient presents to the emergency depament complaining of fever, chills, and a painful mass adjacent to his anus. On examination, a tender, fluctuant mass is palpated. Purulent material is noted through the skin and the diagnosis of ischioanal abscess is made. The patient is taken to the operating room, and incision and drainage of the abscess is performed. During the procedure, the extent of the lesion is underestimated, and the inferior rectal nerve is damaged. This nerve is a direct branch of which of the following nerves?
A patient presents to the emergency depament complaining of fever, chills, and a painful mass adjacent to his anus. On examination, a tender, fluctuant mass is palpated. Purulent material is noted through the skin and the diagnosis of ischioanal abscess is made. The patient is taken to the operating room, and incision and drainage of the abscess is performed. During the procedure, the extent of the lesion is underestimated, and the inferior rectal nerve is damaged. This nerve is a direct branch of which of the following nerves?
π‘ Explanation
**Core Concept**
The inferior rectal nerve is a branch of the pudendal nerve, which plays a crucial role in providing innervation to the external anal sphincter and the perianal skin. This nerve is responsible for controlling the motor function of the external anal sphincter, which is essential for maintaining fecal continence.
**Why the Correct Answer is Right**
The pudendal nerve arises from the sacral nerve roots (S2-S4) and is a key component of the pudendal nerve plexus. It provides motor innervation to the external anal sphincter, the levator ani muscle, and the perineal muscles. The inferior rectal nerve is a direct branch of the pudendal nerve, responsible for providing sensory and motor innervation to the external anal sphincter and the perianal skin. Damage to this nerve can result in anal incontinence and perianal pain.
**Why Each Wrong Option is Incorrect**
**Option A:** The superior rectal nerve is a branch of the inferior mesenteric plexus and provides parasympathetic innervation to the rectum, not the external anal sphincter.
**Option B:** The ilioinguinal nerve provides sensory innervation to the skin of the inguinal region and the upper thigh, not the external anal sphincter or perianal skin.
**Option C:** The obturator nerve provides motor innervation to the adductor muscles of the thigh, not the external anal sphincter or perianal skin.
**Clinical Pearl / High-Yield Fact**
The pudendal nerve is at risk during surgeries involving the posterior pelvic region, such as rectal prolapse repair or pelvic floor reconstruction. Damage to this nerve can result in significant morbidity, including anal incontinence and perianal pain.
**Correct Answer:** C. The pudendal nerve.
β Correct Answer: C. Pudendal nerve
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