Cause Of Abdominal Wall Pain Research Articles

A cross‐sectional study of anterior cutaneous nerve entrapment syndrome at a Japanese emergency department

AbstractBackgroundAnterior cutaneous nerve entrapment syndrome (ACNES) is the most common cause of abdominal wall pain. This study aimed to clarify the proportion of ACNES cases among those of abdominal pain and the clinical characteristics and prognosis of the disease in an emergency department (ED) of a Japanese general hospital.MethodsThe medical records of patients from January 2014 to December 2023 were reviewed, and patients aged 15 years or older with abdominal pain with positivity for Carnett's sign, a good response to trigger point injection (TPI), and an ACNES diagnosis were included. The proportion of ACNES cases among the complaints related to abdominal pain in the ED between 2020 and 2023 was then determined. The recurrence rate was also determined using data from the medical records and telephone follow‐ups.ResultsTwenty‐one patients were included. Their median age was 50 years (range: 16–83 years), 13 (62%) were female, and 11 (52%) had acute‐onset pain. Follow‐up data were available for 11 patients (52%), seven (64%) of whom had recurrent pain for a median period of 1 week after the index visit. The proportion of ACNES cases among those of abdominal pain was 0.11%.ConclusionACNES might be uncommon among patients with abdominal pain in the ED setting although underdiagnosis of this condition might have led to an underestimation of the proportion of cases. Moreover, given the high recurrence rate of abdominal pain associated with ACNES, following up these patients is very important.

Port site endometrioma: a rare cause of abdominal wall pain following laparoscopic surgery

Endometriomas are a rare cause of abdominal wall pain. We report a case of a port site endometrioma presenting with an umbilical swelling. The patient underwent a laparoscopy for pelvic...

Successful Treatment of Abdominal Cutaneous Entrapment Syndrome Using Ultrasound Guided Injection

There are various origins for chronic abdominal pain. About 10-30% of patients with chronic abdominal pain have abdominal wall pain. Unfortunately, abdominal wall pain is not thought to be the first origin of chronic abdominal pain; therefore, patients usually undergo extensive examinations, including diagnostic laparoscopic surgery. Entrapment of abdominal cutaneous nerves at the muscular foramen of the rectus abdominis is a rare cause of abdominal wall pain. If abdominal wall pain is considered in earlier stage of chronic abdominal pain, unnecessary invasive procedures are not required and patients will reach symptom free condition as soon as the diagnosis is made. Here, we report a case of successful treatment of a patient with abdominal cutaneous nerve entrapment syndrome by ultrasound guided injection therapy.

A Commonly Seen Cause Of Abdominal Pain: Abdominal Cutaneous Nerve Entrapment Syndrome

Although abdominal cutaneous nerve entrapment syndrome (ACNES) is accepted as a rare condition, it is a syndrome that should be diagnosed more commonly when the clinical signs cannot explain the cause of abdominal pain. Abdominal pain is commonly considered by physicians to be based on intra-abdominal causes. Consequently, redundant tests and consultations are requested for these patients, and unnecessary surgical procedures may be applied. Patients with this type of pain are consulted to many clinics, and because their definitive diagnoses cannot be achieved, they are assessed as psychiatric patients. Actually, a common cause of abdominal wall pain is nerve entrapment on the lateral edge of the rectus abdominis muscle. In this paper, we would like to share information about the diagnosis and treatment of a patient who, prior to presenting to us, had applied to different clinics for chronic abdominal pain and had undergone many tests and consultations; abdominal surgery was eventually decided.

Chronic Abdominal Wall Pain and Ultrasound-Guided Abdominal Cutaneous Nerve Infiltration: A Case Series

Chronic abdominal wall pain occurs in about 10-30% of patients presenting with chronic abdominal pain. Entrapment of abdominal cutaneous nerves at the lateral border of the rectus abdominis muscle has been attributed as a cause of abdominal wall pain. We report our experience of treating such patients using ultrasound-guided abdominal cutaneous nerve infiltration. We conducted a retrospective audit of abdominal cutaneous nerve infiltration performed in the period between September 2008 to August 2009 in our center. All patients had received local anesthetic and steroid injection under ultrasound guidance. The response to the infiltration was evaluated in the post-procedure telephone review as well as in the follow-up clinic. Brief pain inventory (BPI) and numerical rating scale pain scores were collated from two points: the initial outpatient clinic and the follow up clinic up to 5 months following the injection. Nine patients had abdominal cutaneous nerve injections under ultrasound guidance in the period under review. Six patients reported 50% pain relief or more (responders) while three patients did not. Pain and BPI scores showed a decreasing trend in responders. The median duration of follow-up was 12 weeks. Ultrasound can reliably be used for infiltration of the abdominal cutaneous nerves. This will improve the safety as well as diagnostic utility of the procedure.

Abdominal cutaneous nerve entrapment syndrome after blunt abdominal trauma in an 11-year-old girl

Chronic abdominal pain is a common complaint in children. Pain originating from the abdominal wall is often overlooked. Nevertheless, recognizing this type of pain prevents unnecessary examinations (Editorial: Abdominal wall tenderness test: could Carnett cut costs? Lancet. 1991, 337:1134). Abdominal cutaneous nerve entrapment syndrome (ACNES) is a relatively unknown cause of abdominal wall pain in children. Simple questions and clinical tests, which are discussed in this report, can give a direct clue to this disease. The treatment also is equally simple and effective. We describe an 11-year-old girl with ACNES after blunt abdominal trauma, what we believe has not been reported before. Abdominal wall pain, for example, caused by ACNES, as other types of chronic pain, has a serious impact on a child's well-being and future coping mechanisms with disease and health behavior.

Abdominal Cutaneous Nerve Entrapment Syndrome (ACNES): A Commonly Overlooked Cause of Abdominal Pain

Abdominal cutaneous nerve entrapment syndrome (ACNES) may sound like an esoteric condition rarely seen by clinicians but is a common condition. When a patient is seen for abdominal pain without other clinically significant symptoms, ACNES should be high on the list of likely diagnoses. Beginning in 1792 with J P Frank’s description of the condition he named “peritonitis muscularis,”1 a sampling of pertinent medical literature on this subject2–9 shows how often the subject has been written about over the years. These articles state that abdominal wall pain is often wrongly attributed to intra-abdominal disorders and that this misdirected diagnosis can lead to unnecessary consultation, testing, and even abdominal surgery, all of which can be avoided if the initial examiner makes the right diagnosis. In a study of 117 patients in 1999, Greenbaum10 estimated that the amount of money expended on unnecessary workup was $914 per patient. In 2001, Thompson et al11 noted that an average of $6727 per patient was required for previous diagnostic testing and hospital charges. Hershfield6 listed preliminary diagnoses of patients referred to him as irritable bowel, spastic colon, gastritis, psychoneurosis, depression, anxiety, hysteria, and malingering. Many of these patients were given a psychiatric diagnosis when the actual diagnosis could not be determined. In fact, the most common cause of abdominal wall pain is nerve entrapment at the lateral border of the rectus abdominis muscle;3,5,8,9,12 Carnett,3 in the early 20th century, called this syndrome “intercostal neuralgia” and claimed to have seen three patients per week with this diagnosis and as many as three per day in consultation sessions. In my own primary care practice, I have seen one or two patients with this diagnosis for every 150 patients overall but have seen as many as three such patients per consultation session in a busy evening clinic where 15 or more clinicians were on duty. Acute cases of ACNES are usually seen in the evening, especially in spring and summer, when people are more active. Chronic and recurrent cases are more likely to be seen in the daytime throughout the year. To avoid causing the patient unnecessary anxiety and tension, loss of work time, and both the expense and possible hazard of multiple diagnostic procedures, the first physician examining the patient must establish the diagnosis of ACNES if this condition is present. Compiled from my own experience and that of other investigators who have written about ACNES, the information presented here should give readers the tools necessary for diagnosing and treating this condition.