Anterior cutaneous neurectomy for chronic abdominal wall pain: A case report and review of the literature

McLaughlin, Cory; Gandhi, Artee; Hamner, Chad E.

doi:10.1016/j.epsc.2017.05.005

Cited by 4 publications

(2 citation statements)

References 8 publications

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“…Existing surgical treatments for related conditions, such as ilioinguinal neuroma, intercostal neuralgia and anterior cutaneous nerve entrapment syndrome, include simple excision of the inflamed peripheral nerve/neuroma, and excision and implantation of the freshened proximal nerve segment into local muscle. 13,[15][16][17][18][19][20] Lee et al in 2000 conducted a study on surgical treatment of chronic groin pain in 54 patients with neuromas of the lateral femoral cutaneous, ilioinguinal, iliohypogastric, and genitofemoral nerves. 21 The techniques employed included either neurolysis or resection and burying, and they found that 68% of patients had excellent relief of pain.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Abdominal Wall Neuromas

Chappell

Yang

Dumanian

2021

Plastic and Reconstructive Surgery - Global Open

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Background: Neuromas are an under-recognized contributor to chronic abdominal pain. Other than after mesh inguinal hernia repair, surgical management of painful abdominal wall neuromas has not been well established in the literature. Methods: All patients who underwent surgical treatment for painful abdominal wall neuromas by the senior author at Northwestern Memorial Hospital were reviewed. Patients were treated with neuroma excision and allograft nerve reconstruction and/or with targeted muscle reinnervation (TMR). Follow-up pain surveys were issued to assess pain levels, activities of daily living, and pain medication usage. Results: Twenty patients met inclusion criteria. Eighteen (90%) patients reported improvement in neuropathic pain postoperatively. Two (10%) patients had TMR following failed nerve allograft reconstruction, which led to complete pain resolution. Twenty-seven nerves were treated surgically, the majority of which were abdominal intercostal ( 13), followed by ilioinguinal (10), genitofemoral (3), and iliohypogastric (1). Nerve allograft reconstruction was used alone for 18 procedures, in combination with TMR for 2, and TMR was used alone in 8. In all cases of TMR, the freshened nerve ending after neuroma excision was coapted to a motor nerve of the internal oblique. The mean length of follow-up was 18.9 months (SD ±14.5). Conclusions: This retrospective review demonstrated that 90% (18) of the patients had significant improvement in abdominal neuroma pain postoperatively. These results may help guide providers toward effective management of abdominal wall neuropathic pain.

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Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Abdominal Wall Neuromas

Chappell

Yang

Dumanian

2021

Plastic and Reconstructive Surgery - Global Open

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“…Reported diagnostic clues suggesting ACNES are all related to pain. This pain is often debilitating, sharp or stabbing/burning, and predictably localized in anterior portions of the abdomen (area of the rectus muscle) whereas the benefit of medication is often limited (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). Specific circumstances that aggravate (lifting, stretching, lying on the painful side) or alleviate the discomfort (rest) were reported (8,26).…”

Section: Discussionmentioning

confidence: 99%

Abdominal Wall Pain or Irritable Bowel Syndrome

Siawash

Assen

Ten

et al. 2019

J. pediatr. gastroenterol. nutr.

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Objectives: A questionnaire study demonstrated that some adult patients who were diagnosed with irritable bowel syndrome (IBS) were in fact having an abdominal wall pain syndrome, such as anterior cutaneous nerve entrapment syndrome (ACNES). The aim of the present study was to investigate whether a pediatric version of this questionnaire was useful in diagnosing abdominal wall pain syndromes in children with chronic abdominal pain (CAP). Methods: An 18-item questionnaire was tested in 3 groups of children with CAP: group 1, children who underwent surgery for ACNES (n = 42); group 2, children who were found to have ACNES after an outpatient analysis (n = 57); and group 3, children diagnosed with IBS (n = 53). Qualities including internal consistency (Cronbach α), cut-off points and a ROC-curve were calculated using standard statistical analysis. Results: Questionnaire response rates in the three populations of CAP children ranged from 69% to 92%. When comparing ACNES and IBS groups, 17 of 18 questions were discriminative (P < 0.01, Cronbach α 0.74). Total questionnaire scores ranged from 0 (IBS likely) to 17 points (ACNES likely). A median 13-point score (range 8–17) was found in both ACNES groups. In contrast, a median 8-point score was calculated in children with IBS (range 3–13, P < 0.01). Using an 11-point cut-off score, a child with CAP was diagnosed with ACNES with 86% sensitivity and 89% specificity. A ROC curve with an AUC of 0.94 was obtained. Conclusions: A 17-item questionnaire showed good diagnostic test properties and may aid in distinguishing ACNES from IBS in pediatric populations with chronic abdominal pain.

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Anterior Cutaneous Neurectomy—Child's Play?

Vasu,

Karunakaran,

et al. 2024

Journal of Pediatric Neurology

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Chronic abdominal pain (CAP) is a common entity in the pediatric population and has an extensive differential diagnosis. Anterior cutaneous nerve entrapment syndrome (ACNES) is an etiology that is not often diagnosed and requires an individualized approach. Treatment options for ACNES include nonsurgical and surgical, often a graded approach is used. A 12-year-old boy presented with CAP, and was extensively evaluated as well as underwent multiple abdominal surgeries. He was eventually diagnosed with ACNES and underwent a trial conservative management. Although he initially showed improvement, his pain returned. He later underwent a neurectomy procedure with significant postoperative relief. The patient experienced significant relief postprocedure. He experienced up to 70% relief in pain in the immediate postoperative period and at the end of 3 months, pain was completely absent. The patient was able to return to all his activities including active sports. The diagnosis and management of ACNES is a challenging condition, but this report seeks to highlight its importance as an unusual cause. Literature on the management of this condition is scarce, making it difficult to make informed decisions. Surgical neurectomy is seen as a favored procedure for children with moderate-good pain relief, especially for those who do not respond satisfactorily to local blocks.

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Anterior cutaneous neurectomy for chronic abdominal wall pain: A case report and review of the literature

Cited by 4 publications

References 8 publications

Surgical Treatment of Abdominal Wall Neuromas

Surgical Treatment of Abdominal Wall Neuromas

Abdominal Wall Pain or Irritable Bowel Syndrome

Anterior Cutaneous Neurectomy—Child's Play?

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