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Abdominal cutaneous nerve entrapment syndrome

Rudi M H Roumen, Wouter Vening, Rosanne Wouda, Marc M Scheltinga
BACKGROUND: Anterior cutaneous nerve entrapment syndrome (ACNES) is a neuropathic abdominal wall pain syndrome typically characterized by locally altered skin sensations. On the other hand, visceral disease may also be associated with similar painful and altered skin sensations ("Head zones"). Aim of the study was to determine if patients with acute appendicitis demonstrated somatosensory disturbances in the corresponding right lower quadrant Head zone. METHODS: The presence of somatosensory disturbances such as hyperalgesia, hypoesthesia, altered cool perception, or positive pinch test was determined in 100 patients before and after an appendectomy...
June 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Oliver B Boelens, Robert C Maatman, Marc R Scheltinga, Kees van Laarhoven, Rudi M Roumen
Most patients with chronic back pain suffer from degenerative thoracolumbovertebral disease. However, the following case illustrates that a localized peripheral nerve entrapment must be considered in the differential diagnosis of chronic back pain. We report the case of a 26-year-old woman with continuous excruciating pain in the lower back area. Previous treatment for nephroptosis was to no avail. On physical examination the pain was present in a 2 x 2 cm area overlying the twelfth rib some 4 cm lateral to the spinal process...
March 2017: Pain Physician
Murid Siawash, Frederique Mol, Walther Tjon-A-Ten, Christel Perquin, Percy van Eerten, Ernst van Heurn, Rudi Roumen, Marc Scheltinga
BACKGROUND: Chronic abdominal pain in children may be caused by the anterior cutaneous nerve entrapment syndrome. Local nerve blocks are recommended as an initial treatment in adults. Evidence on effectiveness and safety of such a treatment in children is lacking. AIM: Our aim was to study outcome and adverse events of anterior rectus sheath blocks in childhood anterior cutaneous nerve entrapment syndrome. METHODS: Patients <18 years of age receiving anterior rectus sheath blocks were prospectively followed...
May 2017: Paediatric Anaesthesia
Murid Siawash, Robbert Maatman, Walther Tjon A Ten, Ernst van Heurn, Rudi Roumen, Marc Scheltinga
INTRODUCTION: Anterior cutaneous nerve entrapment syndrome (ACNES) is a relatively unknown cause of severe neuralgic abdominal pain. Treatment includes medication, local nerve blocks or, if unresponsive, a neurectomy of nerve endings. In children, the outcome of neurectomy for ACNES is scantly described in retrospective studies. The objective of this first prospective study was to investigate the safety and short term success rate of anterior neurectomy in a large pediatric population with ACNES...
March 2017: Journal of Pediatric Surgery
Jeremy R Glissen Brown, Gregory R Bernstein, Frank K Friedenberg, Adam C Ehrlich
Chronic abdominal wall pain (CAWP) refers to a condition wherein pain originates from the abdominal wall itself rather than the underlying viscera. According to various estimates, 10% to 30% of patients with chronic abdominal pain are eventually diagnosed with CAWP, usually after expensive testing has failed to uncover another etiology. The most common cause of CAWP is anterior cutaneous nerve entrapment syndrome. The diagnosis of CAWP is made using an oft-forgotten physical examination finding known as Carnett's sign, where focal abdominal tenderness is either the same or worsened during contraction of the abdominal musculature...
November 2016: Journal of Clinical Gastroenterology
Sule Sahin Onat, Ayse Merve Ata, Levent Ozcakar
Meralgia paresthetica refers to the entrapment of the lateral femoral cutaneous nerve at the level of the inguinal ligament. The lateral femoral cutaneous nerve - a purely sensory nerve - arises from the L2 and L3 spinal nerve roots, travels downward lateral to the psoas muscle, and then crosses the iliacus muscle. Close to the anterior superior iliac spine, the nerve courses in contact with the lateral aspect of the inguinal ligament and eventually innervates the lateral thigh. The entrapment syndrome is usually idiopathic but can also ensue due to trauma/overuse, pelvic and retroperitoneal tumors, stretching of the nerve due to prolonged leg/trunk hyperextension, leg length discrepancies, prolonged standing, external compression by belts, weight gain, and tight clothing...
May 2016: Pain Physician
Jelmer E Oor, Çagdas Ünlü, Eric J Hazebroek
BACKGROUND: Abdominal cutaneous nerve entrapment syndrome (ACNES) is a frequently overlooked cause of chronic abdominal pain. We aim to outline the current available literature concerning the treatment of patients diagnosed with ACNES. DATA SOURCES: A systematic search in PubMed, EMBASE, CINAHL, and Cochrane databases was performed. Seven studies were included; describing trigger point injection (TPI) or anterior neurectomy as stand-alone procedure, TPI followed by anterior neurectomy as stepwise regimen, and nerve stimulation and phenolization...
July 2016: American Journal of Surgery
Herbert Koop, Simona Koprdova, Christine Schürmann
BACKGROUND: Chronic abdominal wall pain is a poorly recognized clinical problem despite being an important element in the differential diagnosis of abdominal pain. METHODS: This review is based on pertinent articles that were retrieved by a selective search in PubMed and EMBASE employing the terms "abdominal wall pain" and "cutaneous nerve entrapment syndrome," as well as on the authors' clinical experience. RESULTS: In 2% to 3% of patients with chronic abdominal pain, the pain arises from the abdominal wall; in patients with previously diagnosed chronic abdominal pain who have no demonstrable pathological abnormality, this likelihood can rise as high as 30% ...
January 29, 2016: Deutsches Ärzteblatt International
Sven Weum, Louis de Weerd
BACKGROUND: Pain from the abdominal wall can be caused by nerve entrapment, a condition called abdominal cutaneous nerve entrapment syndrome (ACNES). As an alternative to surgery, ACNES may be treated with injection of local anesthetics, corticosteroids, or botulinum toxin at the point of maximal pain. METHOD: The point of maximal pain was marked on the abdominal skin. Using color Doppler ultrasound, the corresponding exit point of perforating blood vessels through the anterior fascia of the rectus abdominis muscle was identified...
July 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Rajendra Kumar Sahoo, Abhijit S Nair
Anterior cutaneous nerve entrapment syndrome (ACNES) is one the most common cause of chronic abdominal wall pain. The syndrome is mostly misdiagnosed, treated wrongly and inadequately. If diagnosed correctly by history, examination and a positive carnett test, the suffering of the patient can be relieved by addressing the cause i.e. local anaesthetic with steroid injection at the entrapment site. Conventionally, the injection is done by landmark technique. In this report, we have described 2 patients who were diagnosed with ACNES who were offered ultrasound guided transverses abdominis plane (TAP) injection who got significant pain relief for a long duration of time...
October 2015: Korean Journal of Pain
Vincent M A Stirler, Johan T F J Raymakers, Srdjan Rakic
BACKGROUND: The aim of the study was to introduce a new surgical treatment for anterior cutaneous nerve entrapment syndrome, a frequently unrecognised disorder in the general population responsible for chronic abdominal wall pain with limited treatment options to date. We hypothesised that intraperitoneal onlay mesh reinforcement could dissipate excessive increases in intra-abdominal pressure and prevent entrapment of the neurovascular bundle. METHODS: Retrospective cohort analysis was performed between September 2002 and March 2014...
July 2016: Surgical Endoscopy
Murid Siawash, Jenneke W A de Jager-Kievit, Walther Tjon A Ten, Rudi M Roumen, Marc R Scheltinga
OBJECTIVE: Anterior cutaneous nerve entrapment syndrome (ACNES) is a frequently overlooked condition causing chronic abdominal pain (CAP). The objective of the present study was to investigate the rate of ACNES in a pediatric outpatient cohort with CAP. METHODS: A cross-sectional cohort study was conducted in a population 10 to 18 years of age consulting a pediatric outpatient department with new-onset CAP during a 2 years' time period. All individuals were identified through a standard hospital registration system...
March 2016: Journal of Pediatric Gastroenterology and Nutrition
Hapu T Msonda, Jeffrey T Laczek
BACKGROUND: Chronic abdominal pain is a frequently encountered complaint in the primary care setting. The abdominal wall is the etiology of this pain in 10 to 30% of all cases of chronic abdominal pain. Abdominal cutaneous nerve entrapment at the lateral border of the rectus abdominis muscle has been attributed as a cause of this pain. In the military health care system, patients with unexplained abdominal pain are often transferred to military treatment facilities via the Military Medical Evacuation (MEDEVAC) system...
May 2015: Military Medicine
Tijmen van Assen, Jill A G M Brouns, Marc R Scheltinga, Rudi M Roumen
BACKGROUND: Patients with chronic abdominal pain occasionally suffer from the anterior cutaneous nerve entrapment syndrome (ACNES). A substantial number of patients report previous visits to an emergency department (ED) with acute pain. Aim of this study was to obtain the incidence of ACNES in patients presenting with abdominal pain in the ED of a Dutch teaching hospital. METHODS: In this observational study, data sets of all patients visiting Máxima Medical Center's (MMC) ED in 2011-2012 were searched for key terms 'ACNES', 'intercostal neuralgia' or 'abdominal wall pain'...
2015: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Sigrid Bairdain, Pradeep Dinakar, David P Mooney
PURPOSE: The purpose of this manuscript is to report on an entity known as Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) and its relevance to chronic abdominal pain encountered in children. METHODS: Following institutional review board approval, we retrospectively reviewed patients who underwent operation for presumed ACNES from 2011-2014. Variables reviewed included age, gender, age at surgery, time from onset of pain to surgery, additional medical treatments, and surgery performed...
July 2015: Journal of Pediatric Surgery
Tijmen van Assen, Oliver B Boelens, Percy V van Eerten, Christel Perquin, Marc R Scheltinga, Rudi M Roumen
BACKGROUND: Surgery occasionally is proposed in patients with chronic abdominal wall pain caused by an anterior cutaneous nerve entrapment syndrome (ACNES) who are refractory to injection therapy. An anterior neurectomy may seem successful, but follow-up is usually short and populations are small. The primary aim of this study was to determine the long-term success rate of surgery in a large ACNES population. METHODS: In this retrospective observational study, patients with ACNES ≥18 years who underwent a primary anterior neurectomy between January 2004 and February 2012 in one single center were studied...
January 2015: Surgery
Sarah L Nizamuddin, Katharine M Koury, Mary E Lau, Lisa D Watt, Padma Gulur
Anterior cutaneous nerve entrapment syndrome (ACNES) is a commonly overlooked source of chronic abdominal wall pain. A diagnosis of ACNES should be considered in cases of severe, localized abdominal pain that is accentuated by physical activity. Providers should consider diagnosing ACNES once a patient has both a positive result from a Carnett's test and precise localization of pain. We describe the use of transversus abdominus plane (TAP) blocks to treat ACNES in the pediatric patient population. TAP blocks are a treatment modality which have been described less frequently in the management of this syndrome, with rectus sheath blocks being used more commonly...
September 2014: Pain Physician
T van Assen, O B Boelens, P V van Eerten, M R Scheltinga, R M Roumen
BACKGROUND: Injection treatment followed by an anterior neurectomy in patients insufficiently responding to an injection regimen is successful long term in three-quarters of patients with anterior cutaneous nerve entrapment syndrome (ACNES). The efficacy of secondary surgery, including re-exploration or a posterior neurectomy in patients reporting recurrent pain after initially successful surgery or following an immediately failed anterior neurectomy is unknown. METHODS: A database of ACNES patients receiving surgery between 2004 and 2012 in the SolviMáx institution was analysed...
December 2014: World Journal of Surgery
Chrysanthi Batistaki, Theodosios Saranteas, Areti Adoni, Georgia Kostopanagiotou
No abstract text is available yet for this article.
November 2013: Pain Physician
Tijmen van Assen, Jenneke W A J de Jager-Kievit, Marc R Scheltinga, Rudi M H Roumen
INTRODUCTION: The abdominal wall is often neglected as a cause of chronic abdominal pain. The aim of this study was to identify chronic abdominal wall pain syndromes, such as anterior cutaneous nerve entrapment syndrome (ACNES), in a patient population diagnosed with functional abdominal pain, including irritable bowel syndrome, using a validated 18-item questionnaire as an identification tool. METHODS: In this cross-sectional analysis, 4 Dutch primary care practices employing physicians who were unaware of the existence of ACNES were selected...
November 2013: Journal of the American Board of Family Medicine: JABFM
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