Abstract
BackgroundAnterior cutaneous nerve entrapment syndrome (ACNES) is a frequently overlooked cause of chronic abdominal pain in children. Currently, both nonsurgical and surgical treatment options are available to treat this disease. The objective was to give insight into the success rate of different treatment strategies for children with ACNES, and provide treatment recommendations for physicians based on the published evidence. MethodA literature search of PubMed, Embase.com and the Wiley/Cochrane Library was conducted for studies published up to 25 February 2020. Randomized controlled trials, prospective or retrospective cohort studies, meta-analyses and literature reviews describing the outcome of different treatment strategies for children (<18 years old) with ACNES with a follow-up duration of at least four weeks were included. ResultsSix studies, involving 224 patients, were included with an overall quality reported to be between fair and poor. Treatment success of local injections with an anesthetic agent into the trigger point ranged from 38% to 87% with a follow-up ranging from 4 weeks to 39 months. In addition, treatment success of anterior neurectomy ranged from 86% to 100%, with a follow-up duration ranging from 4 weeks to 36 months. ConclusionA step-up treatment strategy should be applied when treating pediatric patients with ACNES. This strategy starts with an injection with a local anesthetic agent, reserving surgery (anterior neurectomy) as a viable option in case of persistent pain. Level of evidenceII.
Highlights
Anterior cutaneous nerve entrapment syndrome (ACNES) is a frequently overlooked cause of chronic abdominal pain in children
Data regarding the exact incidence of anterior cutaneous nerve entrapment syndrome (ACNES) in the pediatric population are lacking, recently ACNES was diagnosed in 13% of children initially diagnosed with functional abdominal pain [15]
Based upon the low quality of data identified, we carefully conclude that nonsurgical treatment of ACNES in the form of injections with a local anesthetic agent is a viable first treatment strategy with success rates reported between 38% and 87%
Summary
Data regarding the exact incidence of ACNES in the pediatric population are lacking, recently ACNES was diagnosed in 13% of children initially diagnosed with functional abdominal pain [15]. Nonsurgical and surgical treatment strategies are available for ACNES, with an overall success rate of up to 85% in the adult population [11,17,19,20,21,22,23]. The preferred nonsurgical treatment is one or multiple injections with a local anesthetic agent (e.g. lidocaine or bupivacaine) into the trigger point, with or without corticosteroids and with or without ultrasound guidance [11,12,16,17,24,25,26,27]. The aim of this systematic review is to summarize the currently available literature regarding the outcome of the different treatment strategies of ACNES in the pediatric population and to provide treatment recommendations for physicians
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