Diagnostic characteristics of anterior cutaneous nerve entrapment syndrome in childhood
Some children suffering from chronic abdominal pain may have an abdominal wall entity such as anterior cutaneous nerve entrapment syndrome. This syndrome is largely suspected on a combination of findings at history and physical examination. The aim is to obtain clues in history and physical examinations in a selected population of children with anterior cutaneous nerve entrapment syndrome. We analyzed all children with abdominal pain visiting our hospital between January 2013 and January 2015. A total of 71 cases were identified (median age 15 years, range 8–17, 77% female). Pain was severe (median 8, range 6–9), stabbing/burning (84%), superficial (88%), aggravated by physical activity (91%), and always in one abdominal area (97%). Hypo-/hyperesthesia (87%) or a positive pinch test (89%) was often found at the skin overlying the painful spot. Increased pain was reported by 97% when the abdominal muscles were tensed (Carnett test). A single anterior rectus sheath block is successful in almost all patients (97%).
What is Known:
• Anterior cutaneous nerve entrapment syndrome (ACNES) is often overlooked in chronic abdominal pain.
• Pediatric literature on diagnostic work up for ACNES is poor.
What is New:
• Two third reported treatment delay due to misdiagnosis as functional abdominal pain.
• Medical history and physical examination revealed neuropathic pain characteristic in up to 90% of the cases.
KeywordsChildren Abdominal wall pain ACNES Carnett
anterior cutaneous nerve entrapment syndrome
numeric pain rating scale
MS collected data, performed analysis, drafted the initial version of the manuscript, and approved the final manuscript as submitted. RR and MRS evaluated patients, revised the initial draft, and approved the final manuscript as submitted. WTA and EvH revised the initial draft and approved the final manuscript as submitted.
This study was funded by a grant from “Fonds Nuts-Ohra.” Authors have no financial relationship with this.
Compliance with ethical statements
Conflict of interest
The authors declare that they have no conflicts of interest.
Written informed consents were obtained from the parents of all participants.
- 2.Applegate WV (2002) Abdominal cutaneous nerve entrapment syndrome (ACNES): a commonly overlooked cause of abdominal pain. Perm J 6:20–27Google Scholar
- 7.Carnett JB (1926) Intercostal neuralgia as a cause of abdominal pain. Surg Gynecol Obstet 42:625–632Google Scholar
- 17.Siawash M, Mol F, Tjon ATW, Perquin C, van Eerten P, van Heurn E, Roumen R, Scheltinga M (2017) Anterior rectus sheath blocks in children with abdominal wall pain due to anterior cutaneous nerve entrapment syndrome: a prospective case series of 85 children. Paediatr Anaesth 27:545–550CrossRefPubMedGoogle Scholar