Anterior rectus sheath blocks in children with abdominal wall pain due to anterior cutaneous nerve entrapment syndrome: a prospective case series of 85 children

2017 ◽  
Vol 27 (5) ◽  
pp. 545-550 ◽  
Author(s):  
Murid Siawash ◽  
Frederique Mol ◽  
Walther Tjon-A-Ten ◽  
Christel Perquin ◽  
Percy van Eerten ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Case Series ◽  
Rectus Sheath ◽  
Nerve Entrapment ◽  
Cutaneous Nerve ◽  
Anterior Rectus Sheath ◽  
Entrapment Syndrome ◽  
Abdominal Wall Pain ◽  
Prospective Case Series ◽  
Nerve Entrapment Syndrome

scholarly journals Use of Targeted Transversus Abdominus Plane Blocks in Pediatric Patients with Anterior Cutaneous Nerve Entrapment Syndrome

2014 ◽  
Vol 5;17 (5;9) ◽  
pp. E623-E627
Author(s):  
Padma Gulur
Keyword(s):  
Chronic Pain ◽  
Abdominal Pain ◽  
Pediatric Patients ◽  
Case Series ◽  
Rectus Sheath ◽  
Nerve Entrapment ◽  
Cutaneous Nerve ◽  
Entrapment Syndrome ◽  
Transversus Abdominus Plane ◽  
Nerve Entrapment Syndrome

Anterior cutaneous nerve entrapment syndrome (ACNES) is a commonly overlooked source of chronic abdominal wall pain. A diagnosis of ACNES should be considered in cases of severe, localized abdominal pain that is accentuated by physical activity. Providers should consider diagnosing ACNES once a patient has both a positive result from a Carnett’s test and precise localization of pain. We describe the use of transversus abdominus plane (TAP) blocks to treat ACNES in the pediatric patient population. TAP blocks are a treatment modality which have been described less frequently in the management of this syndrome, with rectus sheath blocks being used more commonly. TAP blocks can be used effectively for ACNES by targeting the site of maximal tenderness, which was identified using ultrasound guidance. Moreover, TAP blocks are an attractive procedure option for ACNES as they are less invasive than other commonly used techniques. We present 3 case series reports of pediatric patients evaluated at our institution for severe abdominal pain to describe the clinical manifestations, sequelae, and outcome of ACNES. Though the exact incidence of ACNES in the pediatric population is unknown, this condition has significant implications from chronic pain. Chronic pain can lead to significant emotional and social impacts on these pediatric patients, as well as their on their families. Further, the extensive utilization of health care resources is impacted when children with undiagnosed ACNES undergo invasive treatments when ACNES is not in the early differential. The purpose of this case series report is to prompt better recognition of the condition ACNES, and to highlight the efficacy of TAP blocks as a management strategy. Key words: TAP block, pediatric patients, abdominal pain, ACNES

Bilateral distribution of anterior cutaneous nerve entrapment syndrome (ACNES): are clinical features and outcomes comparable to unilateral ACNES?

2019 ◽  
Vol 44 (4) ◽  
pp. 513-520 ◽  
Author(s):  
Robbert C Maatman ◽  
Mads U Werner ◽  
Marc R M Scheltinga ◽  
Rudi M H Roumen
Keyword(s):  
Neuropathic Pain ◽  
Abdominal Wall ◽  
Mirror Image ◽  
The Body ◽  
Nerve Entrapment ◽  
Cutaneous Nerve ◽  
Neuropathic Pain Syndrome ◽  
Entrapment Syndrome ◽  
Abdominal Wall Pain ◽  
Nerve Entrapment Syndrome

Background and objectivesMirror-image pain may occur in the presence of a one-sided peripheral nerve lesion leading to a similar distribution of pain on the contralateral side of the body (“mirrored”). Anterior cutaneous nerve entrapment syndrome (ACNES) is a neuropathic pain syndrome due to entrapment of terminal branches of intercostal nerves T7–12 in the abdominal wall and sometimes presents bilaterally. This study aims to address specifics of bilateral ACNES and to determine potential differences in clinical presentation and treatment outcomes when compared with the unilateral form of ACNES.MethodsElectronic patient files and questionnaires of a case series of patients who were evaluated for chronic abdominal wall pain in a single center were analyzed using standard statistical methods.ResultsBetween June 1, 2011 and September 1, 2016, 1116 patients were diagnosed with ACNES, of which a total of 146 (13%) with bilateral ACNES were identified (female, n = 114, 78 %; median (range) age 36 (1181) years). Average NRS (Numeric Rating Scale; 0–10) scores were similar (median (range) NRS scores 6 (0–10) although peak NRS scores were significantly higher in the bilateral group (9 (5–10) vs 8 (2–10); p=0.02). After a median of 26 months (1–68), the proportion of patients with bilateral ACNES reporting treatment success was 61%.ConclusionsOne in eight patients with ACNES has bilateral abdominal wall pain. Characteristics are similar to unilateral ACNES cases. Further studies aimed at underlying mechanisms in mirror image pain pathogenesis could provide a more targeted approach in the management of this neuropathic pain.

When it is not a Spigelian Hernia: Abdominal Cutaneous Nerve Entrapment Syndrome

2013 ◽  
Vol 79 (10) ◽  
pp. 1111-1114 ◽  
Author(s):  
Shirin Towfigh ◽  
Shannon Anderson ◽  
Andrea Walker
Keyword(s):  
Chronic Pain ◽  
Abdominal Wall ◽  
Nerve Entrapment ◽  
Spigelian Hernia ◽  
Cutaneous Nerve ◽  
Nerve Blocks ◽  
Delay In Diagnosis ◽  
Entrapment Syndrome ◽  
Abdominal Wall Pain ◽  
Nerve Entrapment Syndrome

Abdominal wall pain at the linea semilunaris is classically the result of a Spigelian hernia. If no hernia is detected, these patients may be left with chronic pain without a diagnosis or treatment. A retrospective review was performed of patients presenting with abdominal wall pain at the linea semilunaris between 2009 and 2012. Of the 14 patients, three (21%) were diagnosed with a Spigelian hernia confirmed by imaging. The remaining patients were eventually diagnosed with abdominal cutaneous nerve entrapment syndrome (ACNES). The average delay in diagnosis was 4 years with patients with ACNES suffering twice as long with chronic pain. Patients with a Spigelian hernia and ACNES had different demographics and presenting complaints. Physical examination findings were nondiagnostic. Of the patients with ACNES, five (50%) had resolution of pain with serial nerve blocks alone; another five proceeded to surgical neurectomy with resolution of their pain. Thus, to prevent delay in diagnosis and treatment, patients with chronic abdominal wall pain at the linea semilunaris should first be ruled out for Spigelian hernia. Then, they should be evaluated and treated for ACNES.

Misdiagnosis of anterior cutaneous nerve entrapment syndrome as a somatization disorder

2016 ◽  
Vol 33 (S1) ◽  
pp. S387-S388 ◽  
Author(s):  
M. Arts ◽  
J. Buis ◽  
L. de Jonge
Keyword(s):  
Abdominal Pain ◽  
Depressive Symptoms ◽  
Abdominal Wall ◽  
Nerve Entrapment ◽  
Cutaneous Nerve ◽  
Somatization Disorder ◽  
Abdominal Wall Pain ◽  
Chronic Abdominal Wall Pain ◽  
Nerve Entrapment Syndrome

IntroductionAnterior cutaneous nerve entrapment syndrome (ACNES) is a frequently overlooked disease, causing chronic abdominal wall pain due to entrapment of an anterior cutaneous branch of one or more thoracic intercostal nerves. It is often misdiagnosed as a psychiatric condition, particularly under the heading of a somatization disorder.ObjectivesWe describe the case of a patient who developed depressive symptoms after months of suffering from chronic abdominal wall pain.AimsTo report a case-study, describing ACNES as a cause of persistent depressive symptoms.MethodsA case-study is presented and discussed, followed by a literature review.ResultsA 35-year-female was referred to a psychiatrist for her depressive symptoms and persistent cutaneous abdominal pain for months. There she was diagnosed with a depression and possible somatization disorder and she received psychotherapy. Through Internet search, the patient found ACNES as a possible cause for her persistent abdominal pain. Since administration of anesthetic agents only shortly relieved her symptoms, a surgeon decided to remove the nerve end twigs. After surgery, her somatic problems and depressive mood disappeared.ConclusionThe awareness of ACNES is still very limited in medicine. This may lead to incorrect diagnoses, including psychiatric disorders such as somatization disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Misdiagnosing Abdominal Myofascial Pain Syndrome as Anterior Cutaneous Nerve Entrapment Syndrome: Are we Failing Patients with Nonspecific Abdominal Pain?

2019 ◽  
pp. 91-97
Author(s):  
Niraj G
Keyword(s):  
Abdominal Pain ◽  
Myofascial Pain ◽  
Trigger Point ◽  
Case Series ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
Nerve Entrapment ◽  
Cutaneous Nerve ◽  
Entrapment Syndrome ◽  
Nerve Entrapment Syndrome

Background: Chronic abdominal wall pain (CAWP) is often undiagnosed and results in significant health care use as well as patient suffering. There are two main types: abdominal myofascial pain syndrome (AMPS) and anterior cutaneous nerve entrapment syndrome (ACNES). Although the 2 conditions share clinical similarities, they have subtly distinct unique features. Objectives: To highlight the current practice, elucidate the characteristics of the 2 types of CAWP, and direct the spotlight on abdominal myofascial pain. Study Design: Prospective case series. Setting: Tertiary pain medicine clinic in a university hospital. Methods: As a part of a prospective audit of management of chronic abdominal pain, patients completed brief pain inventory-short form questionnaires at baseline and at 3 months posttrigger point treatment. Results: All 3 patients were misdiagnosed with ACNES. Patient 1 was attending the emergency department once every 5 days prior to being correctly diagnosed with AMPS. Following trigger point treatment, there was a significant reduction in emergency department attendance. Patient 2, with a 10-year history of lower abdominal pain that resulted in severe disability, was able to mobilize following trigger point treatment. Patient 3, with a high opioid use (360 mg per day), was able to discontinue opioids following ultrasound-guided trigger point injection with depot steroids. Limitations: Open label case series in a small cohort. Conclusions: AMPS is as common as the various visceral inflammatory diseases. Lack of awareness, ignoring its existence, and misdiagnosing it may not benefit patients with chronic abdominal pain. Key words: Chronic abdominal wall pain, abdominal myofascial pain syndrome, anterior cutaneous nerve entrapment syndrome, viscerosomatic convergence

Recurrent anterior cutaneous nerve entrapment syndrome (ACNES) in three consecutive pregnancies

2020 ◽  
Vol 13 (9) ◽  
pp. e234619
Author(s):  
Joseph Lane Wilson ◽  
Evan Lutz
Keyword(s):  
Vaginal Delivery ◽  
Gestational Age ◽  
Rectus Sheath ◽  
Nerve Entrapment ◽  
Cutaneous Nerve ◽  
Ultrasound Guided ◽  
Spontaneous Vaginal Delivery ◽  
Entrapment Syndrome ◽  
Upper Abdominal ◽  
Nerve Entrapment Syndrome

A 31-year-old G2P1001 woman at a 30-week gestation presented with a recurrence of pinpoint right upper abdominal wall pain. She had been diagnosed with an anterior cutaneous nerve entrapment syndrome (ACNES) during her first pregnancy at a similar gestational age, a well-described but frequently under-recognised entity. The pain during that pregnancy resolved immediately and completely following normal spontaneous vaginal delivery, however,the pain was worse with this presenting pregnancy. She underwent an ultrasound-guided rectus sheath nerve block at 30 weeks with complete and immediate relief for the remainder of the pregnancy. During a third pregnancy, she suffered another recurrence; however, it was less severe than in the prior pregnancies and was managed conservatively. It again resolved completely and immediately with normal spontaneous vaginal delivery. The pattern of ACNES recurrence during the same gestational age in all three pregnancies with total relief following deliveries demonstrates a clear primary mechanical aetiology.

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