Diagnostic characteristics of anterior cutaneous nerve entrapment syndrome in childhood

Murid Siawash, Rudi Roumen, Walther Tjon A. ten, Ernst van Heurn, Marc Scheltinga

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13 Citations (Scopus)

Abstract

Some children suffering from chronic abdominal pain may have an abdominal wall entity such as anterior cutaneous nerve entrapment syndrome. This syndrome is largely suspected on a combination of findings at history and physical examination. The aim is to obtain clues in history and physical examinations in a selected population of children with anterior cutaneous nerve entrapment syndrome. We analyzed all children with abdominal pain visiting our hospital between January 2013 and January 2015. A total of 71 cases were identified (median age 15 years, range 8–17, 77% female). Pain was severe (median 8, range 6–9), stabbing/burning (84%), superficial (88%), aggravated by physical activity (91%), and always in one abdominal area (97%). Hypo-/hyperesthesia (87%) or a positive pinch test (89%) was often found at the skin overlying the painful spot. Increased pain was reported by 97% when the abdominal muscles were tensed (Carnett test). A single anterior rectus sheath block is successful in almost all patients (97%). Conclusion: A combination of typical findings in history and physical examination allows for diagnosing childhood ACNES.What is Known:• Anterior cutaneous nerve entrapment syndrome (ACNES) is often overlooked in chronic abdominal pain.• Pediatric literature on diagnostic work up for ACNES is poor.What is New:• Two third reported treatment delay due to misdiagnosis as functional abdominal pain.• Medical history and physical examination revealed neuropathic pain characteristic in up to 90% of the cases.
Original languageEnglish
Pages (from-to)835-839
JournalEuropean journal of pediatrics
Volume177
Issue number6
DOIs
Publication statusPublished - 2018

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