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

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. Electronic supplementary material The online version of this article (10.1186/s13256-019-2026-7) contains supplementary material, which is available to authorized users.

Diagnostic challenge of chlamydial Fitz‐Hugh‐Curtis syndrome and cervicitis complicated by appendicitis: Case report

“…Carnett's sign is a useful physical examination for distinguishing abdominal wall pain from visceral pain 8 . Kijima et al 9 reported that it is also useful to detect adhesion‐induced abdominal pain. Meanwhile, Carnett's sign can also be positive in patients with appendicitis 10 .…”

Successful management of adhesion related small bowel ischemia without intestinal resection: A case report and review of literature

“…Intra-abdominal adhesions are fibrous bands between organs or tissues that are usually formed after an abdominal or pelvic operation, an inflammatory process, or an abdominal trauma[18]. In fact, it has been elucidated, that they may develop after abdominal surgeries in about 67% of the cases and in 97% of patients undergoing gynecological procedures[19,4]. However, the formation of adhesions varies among patients and depends on the severity and type of the initial surgery, potential post-operative complications as well as the presence of intra-peritoneal foreign bodies[3].…”

“…Post-operative abdominal adhesions play a pivotal role in SBO detection while 10% of affected patients are attributed to peritonitis and only 5% of SBO cases remain of unknown origin[2]. Generally, abdominal adhesions are created either spontaneously, by an inflammatory process or after a surgical procedure in the abdomen and pelvis[3,4]. Moreover, adhesive SBO (aSBO) occurs in 3% of all laparotomies and 1% during the first postoperative year.…”

Fascial Tear in the Medial Rectus Abdominis Muscle Leading to Anterior Cutaneous Nerve Entrapment Syndrome

“…The point of tenderness is roughly the size of a fingertip, and pressing on the area with a single finger intensifies the pain. Carnett's test (14) should be performed in which the patient contracts the rectus muscle while the physician presses on the point of maximal tenderness. This test differentiates intra-abdominal pain from abdominal wall pain with a reported sensitivity of 78% and 88% specificity, respectively, and is likely an effective cost-saving mechanism (13)(14)(15)(16).…”

“…Carnett's test (14) should be performed in which the patient contracts the rectus muscle while the physician presses on the point of maximal tenderness. This test differentiates intra-abdominal pain from abdominal wall pain with a reported sensitivity of 78% and 88% specificity, respectively, and is likely an effective cost-saving mechanism (13)(14)(15)(16). A diagnostic injection of lidocaine at the point of tenderness will often alleviate symptoms.…”