Abstract

OLIVAN-GONZALVO, G; RUIZ-SERRANO, J; UCLES-MORENO, P  and  FERNANDEZ-SANZ, A. Anterior cutaneous nerve entrapment syndrome: a frequently overlooked cause of chronic abdominal pain in children. Anales Sis San Navarra [online]. 2021, vol.44, n.2, pp.303-307.  Epub Feb 07, 2022. ISSN 1137-6627.  https://dx.doi.org/10.23938/assn.0952.

Anterior cutaneous nerve entrapment syndrome (ACNES) is often overlooked in the differential diagnosis of chronic abdominal pain (CAP).

An 11-year-old boy with CAP previously studied in emergency and digestive services without detecting organic pathology, suggesting a psychosomatic origin. On examination, he showed pain in the abdominal wall located to the area of the terminal branch of the T11 intercostal nerve, with a positive Carnett's sign and a favorable response to injection with local anesthetic at the trigger point. Somatosensory evoked potentials revealed right anterior rectus nerve neuropathy. He was diagnosed with ACNES. As treatment, an ultrasound-guided subfascial injection with lidocaine and dexamethasone into the trigger point was administered. After four months, he remains asymptomatic.

For the treatment of ACNES in pediatrics patients, a step-up strategy should be applied, starting with trigger point injections of lidocaine and dexamethasone and reserving anterior neurectomy for those cases with limited effect of these injections.

Keywords : Anterior cutaneous nerve entrapment syndrome; Carnett's sign; Chronic abdominal pain; Neuropathic pain; Somatosensory evoked potentials.

        · abstract in Spanish     · text in Spanish     · Spanish ( pdf )