anterior cutaneous nerve entrapment syndrome (ACNES)

Introduction

Painful condition of the anterior abdominal wall.

Etiology

• spontaneous occurrence 57%
• following abdominal surgery 28%

Epidemiology

• 78% women in Dutch series

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%

Diagnostic procedures

• diagnosis confirmed if a lidocaine injection into the maximally tender spot reduced pain by >50%

Management

• glucocorticoids + local anesthetic
• pulsed radiofrequency treatment
• neurectomy

prognosis

• after 1-5 years, ~70% of patients >= 50% reduction in pain

More general terms

• entrapment neuropathy; nerve entrapment syndrome; pinched nerve
• syndrome

Additional terms

• abdominal pain