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Diagnostic characteristics of anterior cutaneous nerve entrapment syndrome in childhood

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Abstract

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%).

Conclusion: A combination of typical findings in history and physical examination allows for diagnosing childhood ACNES.

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.

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Abbreviations

ACNES:

anterior cutaneous nerve entrapment syndrome

NPRS:

numeric pain rating scale

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Funding

This study was funded by a grant from “Fonds Nuts-Ohra.” Authors have no financial relationship with this.

Author information

Authors and Affiliations

  1. Department of Surgery and SolviMáx, Center of Excellence for Chronic Abdominal Wall and Groin Pain, Máxima Medical Center, 7777, 5500 MB, Veldhoven, The Netherlands

    Murid Siawash, Rudi Roumen & Marc Scheltinga

  2. Department of Pediatrics, Máxima Medical Center, Veldhoven, The Netherlands

    Walther Tjon A. Ten

  3. Emma Children’s Hospital AMC & VU University medical center, Department of Pediatric Surgery, Amsterdam, The Netherlands

    Ernst van Heurn

Authors
  1. Murid Siawash
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  2. Rudi Roumen
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  3. Walther Tjon A. Ten
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  4. Ernst van Heurn
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  5. Marc Scheltinga
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Contributions

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.

Corresponding author

Correspondence to Murid Siawash.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Informed consent

Written informed consents were obtained from the parents of all participants.

Additional information

Communicated by Mario Bianchetti

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Siawash, M., Roumen, R., Ten, W.T.A. et al. Diagnostic characteristics of anterior cutaneous nerve entrapment syndrome in childhood. Eur J Pediatr 177, 835–839 (2018). https://doi.org/10.1007/s00431-018-3125-y

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  • DOI: https://doi.org/10.1007/s00431-018-3125-y

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