Search
anterior cutaneous nerve entrapment syndrome (ACNES)
Painful condition of the anterior abdominal wall.
Etiology:
- spontaneous occurrence 57%
- following abdominal surgery 28%
Epidemiology:
- 78% women in Dutch series [2]
Pathology:
- end twigs of cutaneous intercostal nerves are entrapped as they penetrate along the lateral border of the rectus abdominis
Clinical manifestations:
- tenderness along the lateral rectus abdomini
- increased tenderness during abdominal-wall tensing maneuvers (Carnett's sign)
- onset gradual in 50%, sudden in others
- pain was at T10 or T11 dermatome level in 61%
Special laboratory:
- diagnosis confirmed if a lidocaine injection into the maximally tender spot reduced pain by >50% [2]
Management:
- glucocorticoids + local anesthetic
- pulsed radiofrequency treatment
- neurectomy
prognosis
- after 1-5 years, ~70% of patients >= 50% reduction in pain [2]
Related
abdominal pain
General
entrapment neuropathy; nerve entrapment syndrome; pinched nerve
syndrome
References
- Boelens OB et al.
Management of anterior cutaneous nerve entrapment syndrome
in a cohort of 139 patients.
Ann Surg 2011 Dec; 254:1054
PMID: 21881494
- Boelens OB et al.
A double-blind, randomized, controlled trial on surgery for
chronic abdominal pain due to anterior cutaneous nerve
entrapment syndrome.
Ann Surg 2013 May; 257:845.
PMID: 23470571
- Mol FMU, Maatman RC, De Joode LEGH et al.
Characteristics of 1116 consecutive patients diagnosed with anterior cutaneous
nerve entrapment syndrome (ACNES).
Ann Surg 2021 Feb; 273:373
PMID: 30817351