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Hernia
Published in: Hernia 3/2018

01-06-2018 | Review

Anterior cutaneous nerve entrapment syndrome (ACNES)

Authors: M. R. Scheltinga, R. M. Roumen

Published in: Hernia | Issue 3/2018

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Abstract

The abdominal wall is frequently overlooked as a potential source of chronic abdominal pain. In anterior cutaneous nerve entrapment syndrome (ACNES), irritated intercostal nerves cause severe abdominal pain. Current textbooks fail to acknowledge ACNES. Aim of the present review is to provide detailed information on patient history, physical examination, and a three-step treatment protocol including abdominal wall injections and a localized removal of terminal branches of intercostal nerves.
Literature
1.
Carnett JB (1926) Intercostal neuralgia as a cause of abdominal pain and tenderness. Surg Gyn Obstet 42:625–632
2.
Applegate WV (1972) Abdominal cutaneous nerve entrapment syndrome. Surgery 71:118–124PubMed
3.
Spinner RJ (2006) Outcomes for peripheral nerve entrapment syndromes. Clin Neurosurg 53:285–294PubMed
4.
Boelens OB, Scheltinga MR, Houterman S, Roumen RM (2013) Randomized clinical trial of trigger point infiltration with lidocaine to diagnose anterior cutaneous nerve entrapment syndrome. Br J Surg 100(2):217–221CrossRefPubMed
5.
Boelens OB, van Assen T, Houterman S, Scheltinga MR, Roumen RM (2013) A double-blind, randomized, controlled trial on surgery for chronic abdominal pain due to anterior cutaneous nerve entrapment syndrome. Ann Surg 257(5):845–849CrossRefPubMed
6.
Boelens OB, Scheltinga MR, Houterman S, Roumen RM (2011) Management of anterior cutaneous nerve entrapment syndrome in a cohort of 139 patients. Ann Surg 254(6):1054–1058CrossRefPubMed
7.
van Assen T, Boelens OB, van Eerten PV, Perquin C, Scheltinga MR, Roumen RM (2015) Long-term success rates after an anterior neurectomy in patients with an abdominal cutaneous nerve entrapment syndrome. Surgery 157(1):137–143CrossRefPubMed
8.
Siawash M, Maatman R, Tjon A Ten W, van Heurn E, Roumen R, Scheltinga M (2017) Anterior neurectomy in children with a recalcitrant anterior cutaneous nerve entrapment syndrome is safe and successful. J Pediatr Surg 52:478–480CrossRefPubMed
9.
Thome J, Egeler C (2006) Abdominal cutaneous nerve entrapment syndrome (ACNES) in a patient with a pain syndrome previously assumed to be of psychiatric origin. World J Biol Psychiatry 7(2):116–118CrossRefPubMed
10.
Mackenzie J (1892) Contribution to the study of sensory symptoms associated with visceral disease. Med Chron XVI:293–322
11.
Head H (1893) On disturbances of sensation with especial reference to the pain of visceral disease, Part I. Brain 16(1–2):1–133CrossRef
12.
Lewis T, Kellgren JH (1939) Observations relating referred pain, visceromotor reflexes and other associated phenomena. Clin Sci 4:47
13.
Cyriax EF (1919) On various conditions that may simulate the referred pains of visceral disease, and the consideration of these from the point view of cause and effect. Practioner 102:314–319
14.
15.
Thompson H, Francis DM (1977) Abdominal-wall tenderness: a useful sign in the acute abdomen. Lancet 2:1053–1054CrossRef
16.
Srinivasan R, Greenbaum DS (2002) Chronic abdominal wall pain: a frequently overlooked problem. Practical approach to diagnosis and management. Am J Gastroenterol 97:824–830PubMed
17.
Takada T, Ikusaka M, Ohira Y, Noda K, Tsukamoto T (2011) Diagnostic usefulness of Carnett’s test in psychogenic abdominal pain. Intern Med 50:213–217CrossRefPubMed
18.
Gray DW, Dixon JM, Seabrook G et al (1988) Is abdominal wall tenderness a useful sign in the diagnosis of non-specific abdominal pain? Ann R Coll Surg Engl 70:233–234PubMedPubMedCentral
19.
Greenbaum DS, Joseph JG (1991) Abdominal wall tenderness test. Lancet 337:1606–1607
20.
Murray GM, Durh DCL (1929) An address on: myofibrositis as a simulator of other maladies. Lancet 19:113–116
21.
22.
Judovitch B, Bates W (1946) Segmental neuralgia in painful syndromes, 2nd edn. Davis Company, Philadelphia
23.
24.
Vogl A (1972) Nerve pain from fascial lacunae. Zentralbl Chir 97(1):31 (Article in German) PubMed
25.
Meier W (1988) Experiences with the “epigastric pain syndrome”. Helv Chir Acta 55:731–736
26.
Langdon DE (2002) Abdominal wall pain will be missed until examinations change! Am J Gastroenterol 97:3207–3208CrossRefPubMed
27.
Lindsetmo RO, Stulberg J (2009) Chronic abdominal wall pain—a diagnostic challenge for the surgeon. Am J Surg 198(1):129–134CrossRefPubMed
28.
van der Graaf T, Verhagen PC, Kerver AL, Kleinrensink GJ (2011) Surgical anatomy of the 10th and 11th intercostal, and subcostal nerves: prevention of damage during lumbotomy. J Urol 186(2):579–583CrossRefPubMed
29.
Copyright © 2006 Pearson Education, Inc., Publishing as Benjamin cummings spinal nerve innervation: back, anterolateral thorax, and abdominal wall figure 13.7b
30.
Applegate WV, Buckwalter NR (1997) Microanatomy of the structures contributing to abdominal cutaneous nerve entrapment syndrome. J Am Board Fam Pract 10:329–332PubMed
31.
Applegate WV (2002) Abdominal cutaneous nerve entrapment syndrome(ACNES): a commonly overlooked cause of abdominal pain. Perm J 6:20–27
32.
McGarrity T, Peters DJ, Thompson C, McGarrity SJ (2000) Outcome of patients with chronic abdominal pain referred to chronic pain clinic. Am J Gastroenterol 95:1812–1816CrossRefPubMed
33.
34.
Graff LG, Robinson D (2001) Abdominal pain and emergency department evaluation. Emerg Med Clin North Am 19(1):123–136CrossRefPubMed
35.
van Assen T, de Jager-Kievit JW, Scheltinga MR, Roumen RM (2013) Chronic abdominal wall pain misdiagnosed as functional abdominal pain. J Am Board Fam Med 26(6):738–744CrossRefPubMed
36.
van Assen T, Boelens OB, Kamphuis JT, Scheltinga MR, Roumen RM (2012) Construction and validation of a questionnaire distinguishing a chronic abdominal wall pain syndrome from irritable bowel syndrome. Frontline Gastroenterol 3(4):288–294CrossRefPubMedPubMedCentral
37.
38.
Körner H, Söndenaa K, Söreide JA, Andersen E, Nysted A, Lende TH, Kjellevold KH (1997) Incidence of acute nonperforated and perforated appendicitis: age-specific and sex-specific analysis. World J Surg 21(3):313–317CrossRefPubMed
39.
Sarbandi HS, Pruss-Kaddatz U, Dohmann R (1989) Abdominal intercostal nerve pain. A contribution to differential diagnosis of acute abdominal pain. Chirurg 60:886–889 (discussion 890) PubMed
40.
Scheltinga MR, Boelens OB, Ten Tjon A (2011) WE, Roumen RM. Surgery for refractory anterior cutaneous nerve entrapment syndrome (ACNES) in children. J Pediatr Surg 46(4):699–703CrossRefPubMed
41.
Davis JH (1936) Segmental neuralgia in childhood simulating visceral disease. JAMA 107:1620–1626CrossRef
42.
Hughes GS (1985) Syndrome of the rectus abdominis muscle mimicking the acute abdomen. Ann Emerg Med 14:694–695CrossRefPubMed
43.
Choi YK, Chou S (1995) Rectus syndrome. Another cause of upper abdominal pain. Reg Anesth 20:347–351PubMed
44.
45.
Feurle GE (2007) Abdominal wall pain—classification, diagnosis and treatment suggestions. Wien Klin Wochenschr 119:633–638CrossRefPubMed
46.
McGrady EM, Marks RL (1988) Treatment of abdominal nerve entrapment syndrome using a nerve stimulator. Ann R Coll Surg 70:120–122
47.
Luz ZZ, Fernandes EC, Sivado M, Kokai E, Szucs P, Safranov BV (2015) Monosynaptic convergence of somatic and visceral C-fiber afferents on projection and local circuit neurons in lamina I: a substrate for referred pain. Pain 156:2024–2051CrossRef
48.
(1991) Abdominal wall tenderness test: could Carnett cut costs? Lancet 337:1134
49.
Costanza CD, Longstreth GF, Liu AL (2004) Chronic abdominal wall pain: clinical features, health care costs, and long-term outcome. Clin Gastroenterol Hepatol 2:395–399CrossRefPubMed
50.
Greenbaum DS, Greenbaum RB, Joseph JG, Natale JE (1994) Chronic abdominal wall pain, diagnostic validity and costs. Digest Dis Sci 39:1935–1941CrossRefPubMed
51.
Cimen A, Celik M, Erdine S (2004) Myofascial pain syndrome in the differential diagnosis of chronic abdominal pain. Agri 16(3):45–47PubMed
52.
Facco E, Ceccherelli F (2005) Myofascial pain mimicking radicular syndromes. Acta Neurochir Suppl 92:147–150CrossRefPubMed
53.
Montenegro ML, Gomide LB, Mateus-Vasconcelos EL, Rosa-e-Silva JC, Candido-dos-Reis FJ, Nogueira AA, Poli-Neto OB (2009) Abdominal myofascial pain syndrome must be considered in the differential diagnosis of pelvic pain. Eur J obstet Gyn Reprod Biol 147:21–24CrossRef
54.
Nazareno J, Ponich T, Gregor J (2005) Long-term follow-up of trigger point injections for abdominal wall pain. Can J Gastroenterol 19(9):561–565CrossRefPubMed
55.
56.
Sharp HT (2003) Myofascial pain syndrome of the abdominal wall for the busy clinician. Clin Obstet Gynecol 46:783–788CrossRefPubMed
57.
58.
Clearfield HR (1982) Diagnosing parietal abdominal pain. Hosp Pract 17:219–227CrossRef
59.
Gschossmann JM, Häuser W, Wesselmann U, Holtmann G (2002) Diagnostic criteria and therapeutic strategies of abdominal pain syndromes. Schmerz 16:476–480CrossRefPubMed
60.
Amir R, Argoff CE, Bennett GJ, Cummins TR, Durieux ME, Gerner P, Gold MS, Porreca F, Strichartz GR (2006) The role of sodium channels in chronic inflammatory and neuropathic pain. J Pain 7(5 Suppl 3):S1–S29CrossRefPubMed
61.
Vlassakov KV, Narang S, Kissin I (2011) Local anesthetic blockade of peripheral nerves for treatment of neuralgias: systematic analysis. Anesth Analg 112(6):1487–1493CrossRefPubMed
62.
Glissen Brown JR, Bernstein GR, Friedenberg FK, Ehrlich AC (2016) Chronic abdominal wall pain: an under-recognized diagnosis leading to unnecessary testing. J Clin Gastroenterol 50:828–835CrossRefPubMed
63.
Doouss TW, Boas RA (1975) The abdominal cutaneous nerve entrapment syndrome. N Z Med J 81:473–475PubMed
64.
Jeynes LC, Gauci CA (2008) Evidence for the use of botulinum toxin in the chronic pain setting—a review of the literature. Pain Pract 8(4):269–276CrossRefPubMed
65.
Skinner AV, Lauder GR (2007) Rectus sheath block: successful use in the chronic pain management of pediatric abdominal wall pain. Paediatr Anaesth 17:1203–1211CrossRefPubMed
66.
Simpson DM, Tyrrell J, De Ruiter J, Campbell FA (2011) Use of ultrasound-guided subcostal transversus abdominis plane blocks in a pediatric patient with chronic abdominal wall pain. Paediatr Anaesth 21(1):88–90CrossRefPubMed
67.
Kanakarajan S, High K, Nagaraja R (2011) Chronic abdominal wall pain and ultrasound-guided abdominal cutaneous nerve infiltration: a case series. Pain Med 12(3):382–386CrossRefPubMed
68.
Batistaki C, Saranteas T, Adoni A, Kostopanagiotou G (2013) Ultrasound-guided anterior abdominal cutaneous nerve block for the management of bilateral abdominal cutaneous nerve entrapment syndrome (ACNES). Pain Phys 16(6):E799–E801
69.
Alnahhas MF, Oxentenko SC, Locke GR 3rd, Hansel S, Schleck CD, Zinsmeister AR, Farrugia G, Grover M (2016) Outcomes of ultrasound-guided trigger point injection for abdominal wall pain. Dig Dis Sci 61:572–577CrossRefPubMed
70.
Hong MJ, Kim YD, Seo DH (2013) Successful treatment of abdominal cutaneous entrapment syndrome using ultrasound guided injection. Korean J Pain 26(3):291–294CrossRefPubMedPubMedCentral
71.
Haynsworth RF Jr, Noe CE (1990) An unusual presentation of intercostal neuralgia. Anesthesiology 73(4):779–780CrossRefPubMed
72.
Luis Téllez Villajos BHO, Moreira Vicente V, de la Calle Reviriego JL, Senosiain Lalastra C, Foruny Olcina JR (2015) Radiofrecuencia pulsada en el tratamiento del síndrome de atrapamiento del nervio cutáneo abdominal. Gastroenterologia y hepatologia 38(1):14–16CrossRefPubMed
73.
Hershfield NB (1992) The abdominal wall. A frequently overlooked source of abdominal pain. J Clin Gastroenterol 14:199–202CrossRefPubMed
74.
Towfigh S, Anderson S, Walker A (2013) When it is not a Spigelian hernia: abdominal cutaneous nerve entrapment syndrome. Am Surg 79(10):1111–1114PubMed
75.
Solmaz I, Talay M, Tekindur Ş, Kurt E (2012) A commonly seen cause of abdominal pain: abdominal cutaneous nerve entrapment syndrome. Agri 24(3):139–141CrossRefPubMed
76.
Zganjer M, Bojić D, Bumči I (2013) 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 15(2):157–160CrossRefPubMedPubMedCentral
77.
Roumen RM, Scheltinga MR (2006) Abdominal intercostal neuralgia: a forgotten cause of abdominal pain.[Article in Dutch]. Ned Tijdschr Geneeskd 150(35):1909–1915PubMed
78.
van Assen T, Boelens OB, van Eerten PV, Scheltinga MR, Roumen RM (2014) Surgical options after a failed neurectomy in anterior cutaneous nerve entrapment syndrome. World J Surg 38(12):3105–3111CrossRefPubMed
79.
Chrona E, Kostopanagiotou G, Damigos D, Batistaki C (2017) Anterior cutaneous nerve entrapment syndrome: management challenges. JPR 10:145–156CrossRef
80.
Suleiman S, Johnston DE (2001) The abdominal wall: an overlooked source of pain. Am Fam Phys 64:431–438
81.
Thompson C, Goodman R, Rowe WA (2001) Abdominal wall syndrome: a costly diagnosis of exclusion. Gastroenterology 120:A637CrossRef
82.
Garcia-Larrea L (2012) Objective pain diagnostics: clinical neurophysiology. Neurophysiol Clin 42(4):187–197CrossRefPubMed
Metadata
Title
Anterior cutaneous nerve entrapment syndrome (ACNES)
Authors
M. R. Scheltinga
R. M. Roumen
Publication date
01-06-2018
Publisher
Springer Paris
Published in
Hernia / Issue 3/2018
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-017-1710-z

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