Characteristics of 1116 Consecutive Patients Diagnosed With Anterior Cutaneous Nerve Entrapment Syndrome (ACNES)

Abstract

Objective: The aim of this study was to discuss patient history and subjective findings at physical examination in a large case series to validate a proposed comprehensive set of major and minor diagnostic criteria. Summary Background Data: Chronic abdominal pain in some patients is caused by the anterior cutaneous nerve entrapment syndrome (ACNES). ACNES is a clinical diagnosis as no functional testing or imaging modalities are available up to date. Methods: This study retrospectively analyzed prospectively obtained data from consecutive patients who received the diagnosis ACNES during evaluation at the SolviMáx Center of Excellence for Abdominal Wall and Groin Pain, Eindhoven, The Netherlands, between June 1, 2011 and September 1, 2016. Questionnaires, standard case forms, and digital case files containing characteristics of individuals were used for analysis. Results: Data of 1116 patients suspected and treated for ACNES consistently showed the presence of the following 4 characteristics: sensory disturbances at the painful abdominal area (78%), a positive pinch sign (78%), a positive Carnett's sign (87%), and a positive response to a modified rectus sheath block (>50% pain reduction, 81%). The majority of patients are female of young or middle age with a normal BMI reporting complaints that occurred spontaneously in either a sudden or gradual timeframe, developing a severe (NRS 6-8) chronic abdominal pain that was only diagnosed after a substantial doctor's delay. Conclusion: A combination of typical findings in history and physical examination, combined with a positive modified rectus sheath block, may allow for diagnosing ACNES in patients with chronic abdominal pain.

Pulsed Radiofrequency Ablation for Anterior Cutaneous Nerve Entrapment Syndrome: A Case Report

“…Although previous literature has indicated up to 42% of patients having complete pain remission after injection of local anesthetic into the abdominal wall alone, patients with persistent pain are forced to search for alternative methods of pain relief. 9,10 The addition of adjuvants to local anesthetic has been attempted for longer duration of pain relief. One such adjuvant, dexamethasone, has been shown to prolong the effect of long-acting anesthetics up to 1,306 minutes.…”

“…Recent retrospective studies have shown that pseudovisceral symptoms, including a change in defecation habits, appetite suppression, nausea, and bloating can be associated with ACNES. 8 Current treatment options include pharmacologic therapy, trigger point injections, ultrasound-guided nerve blocks, chemical neurolysis, and surgical neurectomy. 5 We present a case of a 50-year-old female with chronic abdominal pain who was diagnosed with ACNES.…”

Anterior Cutaneous Nerve Entrapment Syndrome Occurring after Endoscopy

“…In a study of 1,116 patients by Mol et al [7], ACNES was 3.7 times more common in females. While the median age was 42 years, ACNES has been reported in children as well as octogenarians.…”

“…The etiology of ACNES in our patient also presented a challenge. While more than half of ACNES cases arise spontaneously, other known triggers include recent abdominal surgery, abdominal trauma, exercise, pregnancy, and influenza [7]. A case of ACNES thought to be triggered by oral contraceptives has also been reported [14].…”

Wanneer flankpijn op de zenuwen werkt: een nieuwe diagnose?

“…Als de pijnklachten terugkwamen, werd opnieuw een injectie geplaatst met 2-5 ml lidocaïne waaraan 40 mg methylprednison was toegevoegd. Toevoegen van een corticosteroïd is bij ACNES overigens niet zinvol gebleken: die toevoeging bleek in een recente studie naar de effectiviteit daarvan niet te leiden tot een verschil met het injecteren van lidocaïne alleen [10].…”