Anterior cutaneous nerve entrapment syndrome: a frequently overlooked cause of chronic abdominal pain in children
DOI:
https://doi.org/10.23938/ASSN.0952Keywords:
Anterior cutaneous nerve entrapment syndrome, Carnett’s sign, Chronic abdominal pain, Neuropathic pain, Somatosensory evoked potentialsAbstract
Anterior cutaneous nerve entrapment syndrome (ACNES) is often overlooked in the differential diagnosis of chronic abdominal pain (CAP).
An 11-year-old boy with CAP previously studied in emergency and digestive services without detecting organic pathology, suggesting a psychosomatic origin. On examination, he showed pain in the abdominal wall located to the area of the terminal branch of the T11 intercostal nerve, with a positive Carnett’s sign and a favorable response to injection with local anesthetic at the trigger point. Somatosensory evoked potentials revealed right anterior rectus nerve neuropathy. He was diagnosed with ACNES. As treatment, an ultrasound-guided subfascial injection with lidocaine and dexamethasone into the trigger point was administered. After four months, he remains asymptomatic.
For the treatment of ACNES in pediatrics patients, a step-up strategy should be applied, starting with trigger point injections of lidocaine and dexamethasone and reserving anterior neurectomy for those cases with limited effect of these injections.
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