Clinical Communications: Adult| Volume 54, ISSUE 5, e87-e90, May 2018

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Abdominal Cutaneous Nerve Entrapment Syndrome: The Cause of Localized Abdominal Pain in a Young Pregnant Woman

  • Sody A. Naimer
    Reprint Address: Sody A. Naimer, md, Department of Family Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel
    Family Health Center, Clalit Health Services, Eilon Moreh, Israel and Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care Research, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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      Despite the broad differential diagnosis in any patient referring with symptoms involving the chest or abdomen, a small number of conditions overshadow the rest by their probability. Chest and abdominal wall pain continues to constitute a common and expensive overlooked source of pain of unknown cause. In particular, cutaneous nerve entrapment syndrome is commonly encountered but not easily diagnosed unless its specific symptoms are sought and the precise physical examination undertaken.

      Case Report

      A primigravida woman with unbearable abdominal pain was referred repeatedly seeking a solution for her suffering. Numerous laboratory and imaging studies were employed in order to elucidate the cause of her condition. After numerous visits and unnecessary delay, the diagnosis was finally made by a physician fully versed in the field of torso wall pain. The focused physical examination disclosed abdominal cutaneous nerve entrapment syndrome as the diagnosis, and anesthetic infiltration led to immediate alleviation of her pain.

      Why Should an Emergency Physician Be Aware of This?

      Cutaneous nerve entrapment is a common cause of abdominal pain that is reached on the basis of thorough history and physical examination alone. Knowledge dissemination of the various torso wall syndromes is imperative for prompt delivery of suitable care. All emergency physicians should be fully aware of this entity because the diagnosis is based solely on physical examination, and immediate relief can be provided in the framework of the first visit. Wider recognition of this syndrome will promise that such mishaps are not repeated in the future.


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        • Langdon D.E.
        Abdominal wall pain will be missed until examinations change!.
        Am J Gastroenterol. 2002; 97: 3207-3208
        • Kopell H.P.
        • Thompson W.A.
        Peripheral Entrapment Neuropathies.
        Robert E. Kreiger Publishing, Malabar, FL1976: 85-88
        • Applegate W.V.
        Abdominal cutaneous nerve entrapment syndrome (ACNES): a commonly overlooked cause of abdominal pain.
        Perm J. 2002; 6: 20-27
        • Habib P.A.
        • Huang G.S.
        • Mendiola J.A.
        • Yu J.S.
        Anterior chest pain: musculoskeletal considerations.
        Emerg Radiol. 2004; 11: 37-45
        • Bösner S.
        • Becker A.
        • Hani M.A.
        • et al.
        Chest wall syndrome in primary care patients with chest pain: presentation, associated features and diagnosis.
        Fam Pract. 2010; 27: 363-369
        • Suleiman S.
        • Johnston D.E.
        The abdominal wall: an overlooked source of pain.
        Am Fam Physician. 2001; 64: 431-438
        • Srinivasan R.
        • Greenbaum D.S.
        Chronic abdominal wall pain: a frequently overlooked problem. Practical approach to diagnosis and management.
        Am J Gastroenterol. 2002; 97: 824-830
        • Costanza C.D.
        • Longstreth G.F.
        • Liu A.L.
        Chronic abdominal wall pain: clinical features, health care costs, and long-term outcome.
        Clin Gastroenterol Hepatol. 2004; 2: 395-399
        • van Assen T.
        • Brouns J.
        • Scheltinga M.
        • Roumen R.
        Incidence of abdominal pain due to the anterior cutaneous nerve entrapment syndrome in an emergency department.
        Scand J Trauma Resusc Emerg Med. 2015; 23: 2-6
        • Carnett J.B.
        Intercostal neuralgia as a cause of abdominal pain and tenderness.
        Surg Gynecol Obstet. 1926; 42: 625-632
        • Roderick E.
        • Normal B.
        Anterior cutaneous nerve entrapment syndrome: an unusual cause of abdominal pain during pregnancy.
        Int J Obstet Anesth. 2016; 25: 96-97
        • Greenbaum D.S.
        • Joseph J.G.
        Abdominal wall tenderness test.
        Lancet. 1991; 337: 1606-1607
        • Naimer S.A.
        Modified infiltration technique for cutaneous nerve entrapment syndrome.
        Br J Med Med Res. 2015; 8: 672-677
        • Kanakarajan S.
        • High K.
        • Naaraja R.
        Chronic abdominal wall pain and ultrasound guided abdominal cutaneous nerve infiltration: a case series.
        Pain Med. 2011; 12: 382-386
        • Adoni A.
        • Kostopanagiotou G.
        • Saranteas T.
        • Batistak C.
        Ultrasound-guided anterior abdominal cutaneous nerve block for the management of bilateral abdominal cutaneous nerve entrapment syndrome (ACNES).
        Pain Physician. 2013; 16: E799-E801
        • Chrona E.
        • Kostopanagiotou G.
        • Damigos D.
        • Batistaki C.
        Anterior cutaneous nerve entrapment syndrome: management challenges.
        J Pain Res. 2017; 10: 145-156
        • Boelens O.B.
        • van Assen T.
        • Houterman S.
        • Scheltinga M.R.
        • Roumen R.M.
        A double-blind, randomized, controlled trial on surgery for chronic abdominal pain due to anterior cutaneous nerve entrapment syndrome.
        Ann Surg. 2013; 257: 845-849
        • Boelens O.B.
        • Scheltinga M.R.
        • Houterman S.
        • Roumen R.M.
        Management of anterior cutaneous nerve entrapment syndrome in a cohort of 139 patients.
        Ann Surg. 2011; 254: 1054-1058
        • Zganjer M.
        • Bojic D.
        • Bumci I.
        Surgery for abdominal wall pain caused by cutaneous nerve entrapment in children—a single institution experience in the last 5 years.
        Iran Red Crescent Med J. 2013; 15: 157-160