Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Journal of Medical Case Reports
Published in: Journal of Medical Case Reports 1/2019

Open Access 01-12-2019 | Key Symptom | Case report

Adhesion-induced chronic abdominal pain: a case report on the diagnostic value of Carnett’s test

Published in: Journal of Medical Case Reports | Issue 1/2019

Login to get access

Abstract

Background

Chronic abdominal pain is a common clinical problem. However, diagnosing chronic abdominal pain often requires detailed diagnostic evaluations in addition to sufficient history taking and physical examination, owing to its uncertain etiology.

Case presentation

We report a case of a 36-year-old man with chronic abdominal pain originating from postoperative adhesions. Postoperative adhesions are common phenomena, and abdominal surgery can cause severe abdominal pain, the source of which can be difficult to detect. Carnett’s test is useful to detect abdominal wall tenderness and to determine the affected abdominal quadrant. Incorporating its use with a detailed chronological clinical history contributes to the improvement of diagnostic accuracy. In addition to the above-mentioned information, attention to subtle imaging findings may provide greater diagnostic accuracy.

Conclusions

Abdominal pain induced by postoperative adhesions was reduced by laparoscopic adhesiolysis. Carnett’s test is an effective tool for evaluating pain and detecting its cause.
Appendix
Available only for authorised users
Literature
1.
Wong KC. How to apply clinical cases and medical literature in the framework of a modified “failure mode and effects analysis” as a clinical reasoning tool—an illustration using the human biliary system. J Med Case Rep. 2016;10:85.CrossRef
2.
Kaufman M, Singh G, Das S, Concha-Parra R, Erber J, Micames C, et al. Efficacy of endoscopic ultrasound-guided celiac plexus block and celiac plexus neurolysis for managing abdominal pain associated with chronic pancreatitis and pancreatic cancer. J Clin Gastroenterol. 2010;44:127–34.CrossRef
3.
4.
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
5.
Sharpstone D, Colin-Jones DJG. Chronic, non-visceral abdominal pain. Gut. 1994;35:833–6.CrossRef
6.
Suleiman S, Johnston DE. The abdominal wall: an overlooked source of pain. Am Fam Physician. 2001;64:431–8.PubMed
7.
Gallegos N, Hobsley M. Abdominal wall pain: an alternative diagnosis. Br J Surg. 1990;77:1167–70.CrossRef
8.
Greenbaum DS, Greenbaum RB, Joseph JG, Natale JE. Chronic abdominal wall pain. Dig Dis Sci. 1994;39:1935–41.CrossRef
9.
Kresch AJ, Seifer DB, Sachs LB, Barrese I. Laparoscopy in 100 women with chronic pelvic pain. Obstet Gynecol. 1984;64:672–4.PubMed
10.
Mousavi SR, Zirakzadeh H, Samsami M, Fallah M, Shirazi FH. Superior mesenteric artery aneurysm in a patient with chronic abdominal pain. Acta Med Iran. 2011;49:766–8.PubMed
11.
Ghaly AF, Chien PF. Chronic pelvic pain: clinical dilemma or clinician’s nightmare. Sex Transm Infect. 2000;76:419–25.CrossRef
12.
Mannion M, Cron RQ. Successful treatment of pediatric IgG4 related systemic disease with mycophenolate mofetil: case report and a review of the pediatric autoimmune pancreatitis literature. Ped Rheumatol Online J. 2011;9:1.CrossRef
13.
Simon A, van der Meer JW, Drenth JP. Familial Mediterranean fever—a not so unusual cause of abdominal pain. Best Pract Res Clin Gastroenterol. 2005;19:199–213.CrossRef
14.
Shayani V, Siegert C, Favia P. The role of laparoscopic adhesiolysis in the treatment of patients with chronic abdominal pain or recurrent bowel obstruction. JSLS. 2002;6:111–4.PubMedPubMedCentral
15.
McClain GD, Redan JA, McCarus SD, Caceres A, Kim J. Diagnostic laparoscopy and adhesiolysis: does it help with complex abdominal and pelvic pain syndrome (CAPPS) in general surgery? JSLS. 2011;15:1–5.CrossRef
16.
Nezhat FR, Crystal RA, Nezhat CH, Nezhat CR. Laparoscopic adhesiolysis and relief of chronic pelvic pain. JSLS. 2000;4:281–5.PubMedPubMedCentral
17.
Perkins FM, Kehlet H. Chronic pain as an outcome of surgery: a review of predictive factors. Anesthesiology. 2000;93:1123–33.CrossRef
18.
Takada T, Ikusaka M, Ohira Y, Noda K, Tsukamoto T. Diagnostic usefulness of Carnett’s test in psychogenic abdominal pain. Intern Med. 2011;50:213–7.CrossRef
19.
Matsunaga S, Eguchi Y. Importance of a physical examination for efficient differential diagnosis of abdominal pain: diagnostic usefulness of Carnett’s test in psychogenic abdominal pain. Intern Med. 2011;50:177–8.CrossRef
20.
Carnett JB. Intercostal neuralgia as a cause of abdominal pain and tenderness. Surg Gynecol Obstet. 1926;42:625–32.
21.
Gray DW, Dixon JM, Seabrook G, Collin J. Is abdominal wall tenderness a useful sign in the diagnosis of non-specific abdominal pain? Ann R Coll Surg Engl. 1988;70:233–4.PubMedPubMedCentral
22.
Lindsetmo RO, Stulberg J. Chronic abdominal wall pain—a diagnostic challenge for the surgeon. Am J Surg. 2009;198:129–34.CrossRef
23.
van Assen T, Brouns JA, Scheltinga MR, Roumen RM. Incidence of abdominal pain due to the anterior cutaneous nerve entrapment syndrome in an emergency department. Scand J Trauma Resusc Emerg Med. 2015;23:19.CrossRef
24.
Tytgat GN. Hyoscine butylbromide: a review of its use in the treatment of abdominal cramping and pain. Drugs. 2007;67:1343–57.CrossRef
25.
Tytgat GN. Hyoscine butylbromide – a review on its parenteral use in acute abdominal spasm and as an aid in abdominal diagnostic and therapeutic procedures. Curr Med Res Opin. 2008;24:3159–73.CrossRef
26.
Szomstein S, Lo Menzo E, Simpfendorfer C, Zundel N, Rosenthal RJ. Laparoscopic lysis of adhesions. World J Surg. 2006;30:535–40.CrossRef
27.
28.
Mueller MD, Tschudi J, Herrmann U, Klaiber C. An evaluation of laparoscopic adhesiolysis in patients with chronic abdominal pain. Surg Endosc. 1995;9:802–4.CrossRef
29.
Freys S, Fuchs K, Heimbucher J, Thiede A. Laparoscopic adhesiolysis. Surg Endosc. 1994;8:1202–7.CrossRef
30.
Keltz MD, Gera PS, Olive DL. Prospective randomized trial of right-sided paracolic adhesiolysis for chronic pelvic pain. JSLS. 2006;10:443.PubMedPubMedCentral
31.
Brüggmann D, Tchartchian G, Wallwiener M, Münstedt K, Tinneberg HR, Hackethal A. Intra-abdominal adhesions: definition, origin, significance in surgical practice, and treatment options. Dtsch Arztebl Int. 2010;107:769–75.PubMedPubMedCentral
32.
Swank D, Swank-Bordewijk S, Hop W, Van Erp W, Janssen I, Bonjer H, et al. Laparoscopic adhesiolysis in patients with chronic abdominal pain: a blinded randomised controlled multi-centre trial. Lancet. 2003;361:1247–51.CrossRef
33.
Paajanen P, Fagerstrom A, Paajanen H. Laparoscopic adhesiolysis in chronic abdominal pain: 15-year follow-up study. J Clin Gastroenterol. 2018;52:e32–6.CrossRef
34.
Rose M, Eliakim R, Bar-Ziv Y, Vromen A, Rachmilewitz D. Abdominal wall hernias: the value of computed tomography diagnosis in the obese patient. J Clin Gastroenterol. 1994;19:94–6.CrossRef
Metadata
Title
Adhesion-induced chronic abdominal pain: a case report on the diagnostic value of Carnett’s test
Publication date
01-12-2019
Published in
Journal of Medical Case Reports / Issue 1/2019
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/s13256-019-2026-7

Other articles of this Issue 1/2019

Journal of Medical Case Reports 1/2019 Go to the issue

Case report

Endoscopic removal of a gastric pharmacobezoar induced by clomipramine, lorazepam, and domperidone overdose: a case report

Case report

A rare rib lesion due to parosteal osteosarcoma: a case report

Case report

Diagnosis and treatment of oral focal mucinosis: a case series

Case report

Congenital absence of lingual frenum in a non-syndromic patient: a case report

Case report

Ethylene glycol intoxication following brake fluid ingestion complicated with unilateral facial nerve palsy: a case report

Case report

Hypothyroidism manifesting as multiple cranial neuropathies: a case report