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Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2015

Open Access 01-12-2015 | Original research

Incidence of abdominal pain due to the anterior cutaneous nerve entrapment syndrome in an emergency department

Authors: Tijmen van Assen, Jill A G M Brouns, Marc R Scheltinga, Rudi M Roumen

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2015

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Abstract

Background

Patients with chronic abdominal pain occasionally suffer from the anterior cutaneous nerve entrapment syndrome (ACNES). A substantial number of patients report previous visits to an emergency department (ED) with acute pain. Aim of this study was to obtain the incidence of ACNES in patients presenting with abdominal pain in the ED of a Dutch teaching hospital.

Methods

In this observational study, data sets of all patients visiting Máxima Medical Center’s (MMC) ED in 2011–2012 were searched for key terms ‘ACNES’, ‘intercostal neuralgia’ or ‘abdominal wall pain’. Files of potential patients living within hospital’s adherence area were checked using accepted criteria indicating the presence of ACNES. Disease incidence was calculated as a ratio to the hospital’s adherence data. The ACNES MMC 2013’s incidence in patients evaluated in the surgical outpatient department was also calculated.

Results

During the study period, 473 ED patient files met inclusion criteria. A total of 88 patients belonging to MMC’s adherence area were diagnosed with ACNES leading to a mean 22/100.000 ACNES yearly incidence rate. About one of 50 patients with abdominal pain visiting the ED suffered from ACNES. A 35/100.000 outpatient department ACNES incidence rate was calculated in the year of 2013. Combining these two ratios, a 1:1800 ACNES incidence in the general population was obtained.

Conclusions

In an ED setting of a Dutch teaching hospital, approximately 2% of patients presenting with acute abdominal pain suffered from ACNES. ED physicians should consider ACNES in abdominal pain patients with normal laboratory or imaging tests.
Literature
1.
go back to reference Applegate WV. Abdominal cutaneous nerve entrapment syndrome. Surgery. 1972;71:118–24.PubMed Applegate WV. Abdominal cutaneous nerve entrapment syndrome. Surgery. 1972;71:118–24.PubMed
2.
go back to reference Applegate WV. Abdominal Cutaneous Nerve Entrapment Syndrome (ACNES): a commonly overlooked cause of abdominal pain. Perm J. 2002;6:20–7. Applegate WV. Abdominal Cutaneous Nerve Entrapment Syndrome (ACNES): a commonly overlooked cause of abdominal pain. Perm J. 2002;6:20–7.
3.
go back to reference Carnett J. Intercostal neuralgia as a cause of abdominal pain and tenderness. Surg Gynecol Obstet. 1926;42:8. Carnett J. Intercostal neuralgia as a cause of abdominal pain and tenderness. Surg Gynecol Obstet. 1926;42:8.
4.
go back to reference Choi YK, Chou S. Rectus syndrome. Another cause of upper abdominal pain. Reg Anesth. 1995;20:347–51.PubMed Choi YK, Chou S. Rectus syndrome. Another cause of upper abdominal pain. Reg Anesth. 1995;20:347–51.PubMed
5.
go back to reference Hershfield NB. The abdominal wall. A frequently overlooked source of abdominal pain. J Clin Gastroenterol. 1992;14:199–202.CrossRefPubMed Hershfield NB. The abdominal wall. A frequently overlooked source of abdominal pain. J Clin Gastroenterol. 1992;14:199–202.CrossRefPubMed
6.
go back to reference Roumen RM, Scheltinga MR. Abdominal intercostal neuralgia: a forgotten cause of abdominal pain. Ned Tijdschr Geneeskd. 2006;150:1909–15.PubMed Roumen RM, Scheltinga MR. Abdominal intercostal neuralgia: a forgotten cause of abdominal pain. Ned Tijdschr Geneeskd. 2006;150:1909–15.PubMed
7.
go back to reference Srinivasan R, Greenbaum DS. Chronic abdominal wall pain: a frequently overlooked problem. Practical approach to diagnosis and management. Am J Gastroenterol. 2002;97:824–30.PubMed Srinivasan R, Greenbaum DS. Chronic abdominal wall pain: a frequently overlooked problem. Practical approach to diagnosis and management. Am J Gastroenterol. 2002;97:824–30.PubMed
8.
go back to reference Suleiman S, Johnston DE. The abdominal wall: an overlooked source of pain. Am Fam Physician. 2001;64:431–8.PubMed Suleiman S, Johnston DE. The abdominal wall: an overlooked source of pain. Am Fam Physician. 2001;64:431–8.PubMed
9.
go back to reference Thomson WH, Dawes RF, Carter SS. Abdominal wall tenderness: a useful sign in chronic abdominal pain. Br J Surg. 1991;78:223–5.CrossRefPubMed Thomson WH, Dawes RF, Carter SS. Abdominal wall tenderness: a useful sign in chronic abdominal pain. Br J Surg. 1991;78:223–5.CrossRefPubMed
11.
go back to reference van Assen T, de Jager-Kievit JW, Scheltinga MR, Roumen RM. Chronic abdominal wall pain misdiagnosed as functional abdominal pain. J Am Board Fam Med. 2013;26:738–44.CrossRefPubMed van Assen T, de Jager-Kievit JW, Scheltinga MR, Roumen RM. Chronic abdominal wall pain misdiagnosed as functional abdominal pain. J Am Board Fam Med. 2013;26:738–44.CrossRefPubMed
12.
go back to reference Boelens OB, Scheltinga MR, Houterman S, Roumen RM. Management of anterior cutaneous nerve entrapment syndrome in a cohort of 139 patients. Ann Surg. 2011;254:1054–8.CrossRefPubMed Boelens OB, Scheltinga MR, Houterman S, Roumen RM. Management of anterior cutaneous nerve entrapment syndrome in a cohort of 139 patients. Ann Surg. 2011;254:1054–8.CrossRefPubMed
13.
go back to reference Boelens OB, Scheltinga MR, Houterman S, Roumen RM. Randomized clinical trial of trigger point infiltration with lidocaine to diagnose anterior cutaneous nerve entrapment syndrome. Br J Surg. 2013;100:217–21.CrossRefPubMed Boelens OB, Scheltinga MR, Houterman S, Roumen RM. Randomized clinical trial of trigger point infiltration with lidocaine to diagnose anterior cutaneous nerve entrapment syndrome. Br J Surg. 2013;100:217–21.CrossRefPubMed
14.
go back to reference Boelens OB, van Assen T, Houterman S, Scheltinga MR, Roumen RM. A double-blind, randomized, controlled trial on surgery for chronic abdominal pain due to anterior cutaneous nerve entrapment syndrome. Ann Surg. 2013;257:845–9.CrossRefPubMed Boelens OB, van Assen T, Houterman S, Scheltinga MR, Roumen RM. A double-blind, randomized, controlled trial on surgery for chronic abdominal pain due to anterior cutaneous nerve entrapment syndrome. Ann Surg. 2013;257:845–9.CrossRefPubMed
15.
go back to reference Scheltinga MR, Boelens OB, Tjon ATWE, Roumen RM. Surgery for refractory anterior cutaneous nerve entrapment syndrome (ACNES) in children. J Pediatr Surg. 2011;46:699–703.CrossRefPubMed Scheltinga MR, Boelens OB, Tjon ATWE, Roumen RM. Surgery for refractory anterior cutaneous nerve entrapment syndrome (ACNES) in children. J Pediatr Surg. 2011;46:699–703.CrossRefPubMed
16.
go back to reference van Assen T, Boelens OB, van Eerten PV, Perquin C, Scheltinga MR, Roumen RM. Long-term success following an anterior neurectomy in patients with an abdominal cutaneous nerve entrapment syndrome. Surgery. 2015;157:137–43.CrossRefPubMed van Assen T, Boelens OB, van Eerten PV, Perquin C, Scheltinga MR, Roumen RM. Long-term success following an anterior neurectomy in patients with an abdominal cutaneous nerve entrapment syndrome. Surgery. 2015;157:137–43.CrossRefPubMed
17.
go back to reference van Assen T, Boelens OB, van Eerten PV, Scheltinga MR, Roumen RM. Surgical options after a failed neurectomy in anterior cutaneous nerve entrapment syndrome. World J Surg. 2014;38:3105–11.CrossRefPubMed van Assen T, Boelens OB, van Eerten PV, Scheltinga MR, Roumen RM. Surgical options after a failed neurectomy in anterior cutaneous nerve entrapment syndrome. World J Surg. 2014;38:3105–11.CrossRefPubMed
18.
go back to reference Thomson H, Francis DM. Abdominal-wall tenderness: A useful sign in the acute abdomen. Lancet. 1977;2:1053–4.CrossRefPubMed Thomson H, Francis DM. Abdominal-wall tenderness: A useful sign in the acute abdomen. Lancet. 1977;2:1053–4.CrossRefPubMed
19.
go back to reference van Assen T, Boelens OB, Kamphuis JT, Scheltinga MR, Roumen RM. Construction and validation of a questionnaire distinguishing a chronic abdominal wall pain syndrome from irritable bowel syndrome. Frontline Gastroenterol. 2012;3:288–94.CrossRefPubMedCentralPubMed van Assen T, Boelens OB, Kamphuis JT, Scheltinga MR, Roumen RM. Construction and validation of a questionnaire distinguishing a chronic abdominal wall pain syndrome from irritable bowel syndrome. Frontline Gastroenterol. 2012;3:288–94.CrossRefPubMedCentralPubMed
20.
go back to reference Greenbaum DS, Greenbaum RB, Joseph JG, Natale JE. Chronic abdominal wall pain. Diagnostic validity and costs. Dig Dis Sci. 1994;39:1935–41.CrossRefPubMed Greenbaum DS, Greenbaum RB, Joseph JG, Natale JE. Chronic abdominal wall pain. Diagnostic validity and costs. Dig Dis Sci. 1994;39:1935–41.CrossRefPubMed
21.
go back to reference Brewer BJ, Golden GT, Hitch DC, Rudolf LE, Wangensteen SL. Abdominal pain. An analysis of 1,000 consecutive cases in a University Hospital emergency room. Am J Surg. 1976;131:219–23.CrossRefPubMed Brewer BJ, Golden GT, Hitch DC, Rudolf LE, Wangensteen SL. Abdominal pain. An analysis of 1,000 consecutive cases in a University Hospital emergency room. Am J Surg. 1976;131:219–23.CrossRefPubMed
22.
go back to reference Kamin RA, Nowicki TA, Courtney DS, Powers RD. Pearls and pitfalls in the emergency department evaluation of abdominal pain. Emerg Med Clin North Am. 2003;21:61–72.CrossRefPubMed Kamin RA, Nowicki TA, Courtney DS, Powers RD. Pearls and pitfalls in the emergency department evaluation of abdominal pain. Emerg Med Clin North Am. 2003;21:61–72.CrossRefPubMed
23.
go back to reference Powers RD, Guertler AT. Abdominal pain in the ED: stability and change over 20 years. Am J Emerg Med. 1995;13:301–3.CrossRefPubMed Powers RD, Guertler AT. Abdominal pain in the ED: stability and change over 20 years. Am J Emerg Med. 1995;13:301–3.CrossRefPubMed
24.
go back to reference Loos MJ, Scheltinga MR, Roumen RM. Tailored neurectomy for treatment of postherniorrhaphy inguinal neuralgia. Surgery. 2010;147:275–81.CrossRefPubMed Loos MJ, Scheltinga MR, Roumen RM. Tailored neurectomy for treatment of postherniorrhaphy inguinal neuralgia. Surgery. 2010;147:275–81.CrossRefPubMed
25.
go back to reference ChipSoft. ChipSoft - Electronic Health and Information System Amsterdam. 2013. ChipSoft. ChipSoft - Electronic Health and Information System Amsterdam. 2013.
26.
go back to reference Abdominal wall tenderness test: could Carnett cut costs? Lancet. 1991;337:1134. Abdominal wall tenderness test: could Carnett cut costs? Lancet. 1991;337:1134.
27.
go back to reference Ranger I, Mehta M, Pennington M. Abdominal wall pain due to nerve entrapment. Practitioner. 1971;206:791–2.PubMed Ranger I, Mehta M, Pennington M. Abdominal wall pain due to nerve entrapment. Practitioner. 1971;206:791–2.PubMed
30.
go back to reference Heij HA, Go PNMYH, Kazemier G, Puylaert JBM, Offringa M, Schilthuis MS, Hajenius PJ, Van Dieijen-Visser M. [Richtlijn voor diagnostiek en behandeling van acute appendicitis.] Utrecht; Nvvh; 2010: 89. Heij HA, Go PNMYH, Kazemier G, Puylaert JBM, Offringa M, Schilthuis MS, Hajenius PJ, Van Dieijen-Visser M. [Richtlijn voor diagnostiek en behandeling van acute appendicitis.] Utrecht; Nvvh; 2010: 89.
Metadata
Title
Incidence of abdominal pain due to the anterior cutaneous nerve entrapment syndrome in an emergency department
Authors
Tijmen van Assen
Jill A G M Brouns
Marc R Scheltinga
Rudi M Roumen
Publication date
01-12-2015
Publisher
BioMed Central
DOI
https://doi.org/10.1186/s13049-015-0096-0

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