Anterior cutaneous nerve entrapment syndrome: A frequently overlooked cause of chronic abdominal pain in children

Abstract

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 ultra-sound-guided subfascial injection with lidocaine and dexamethasone into the trigger point was adminis-tered. 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.