Acute Appendicitis, Somatosensory Disturbances (“Head Zones”), and the Differential Diagnosis of Anterior Cutaneous Nerve Entrapment Syndrome (ACNES)

Roumen, R. M. H.; Vening, Wouter; Wouda, Rosanne; Scheltinga, Marc

doi:10.1007/s11605-017-3417-y

Cited by 15 publications

(7 citation statements)

References 10 publications

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“…The same authors reported that 50% to 56% of patients with acute appendicitis showed segmental signs over the right abdominal quadrant, with the maximum located approximately at McBurney point [ 43 ]. These findings were recently confirmed by Roumen and colleagues [ 44 ], who reported that 39% of patients with acute appendicitis demonstrated at least one segmental sign (ie, hyperalgesia, hypoesthesia, altered cool perception, or positive pinch test) over the lower right abdomen. Finally, a large number of smaller studies and case reports have been published, which have been reviewed by Beal [ 45 ].…”

Section: Discussionsupporting

confidence: 58%

Lateralization and Bodily Patterns of Segmental Signs and Spontaneous Pain in Acute Visceral Disease: Observational Study

et al. 2021

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Background The differential diagnosis of acute visceral diseases is a challenging clinical problem. Older literature suggests that patients with acute visceral problems show segmental signs such as hyperalgesia, skin resistance, or muscular defense as manifestations of referred visceral pain in somatic or visceral tissues with overlapping segmental innervation. According to these sources, the lateralization and segmental distribution of such signs may be used for differential diagnosis. Segmental signs and symptoms may be accompanied by spontaneous (visceral) pain, which, however, shows a nonsegmental distribution. Objective This study aimed to investigate the lateralization (ie, localization on one side of the body, in preference to the other) and segmental distribution (ie, surface ratio of the affected segments) of spontaneous pain and (referred) segmental signs in acute visceral diseases using digital pain drawing technology. Methods We recruited 208 emergency room patients that were presenting for acute medical problems considered by triage as related to internal organ disease. All patients underwent a structured 10-minute bodily examination to test for various segmental signs and spontaneous visceral pain. They were further asked their segmental symptoms such as nausea, meteorism, and urinary retention. We collected spontaneous pain and segmental signs as digital drawings and segmental symptoms as binary values on a tablet PC. After the final diagnosis, patients were divided into groups according to the organ affected. Using statistical image analysis, we calculated mean distributions of pain and segmental signs for the heart, lungs, stomach, liver/gallbladder, and kidneys/ureters, analyzing the segmental distribution of these signs and the lateralization. Results Of the 208 recruited patients, 110 (52.9%) were later diagnosed with a single-organ problem. These recruited patients had a mean age of 57.3 (SD 17.2) years, and 40.9% (85/208) were female. Of these 110 patients, 85 (77.3%) reported spontaneous visceral pain. Of the 110, 81 (73.6%) had at least 1 segmental sign, and the most frequent signs were hyperalgesia (46/81, 57%), and muscle resistance (39/81, 48%). While pain was distributed along the body midline, segmental signs for the heart, stomach, and liver/gallbladder appeared mostly ipsilateral to the affected organ. An unexpectedly high number of patients (37/110, 33.6%) further showed ipsilateral mydriasis. Conclusions This study underlines the usefulness of including digitally recorded segmental signs in bodily examinations of patients with acute medical problems.

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Section: Discussionsupporting

confidence: 58%

Lateralization and Bodily Patterns of Segmental Signs and Spontaneous Pain in Acute Visceral Disease: Observational Study

et al. 2021

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“…The same authors reported, that 50 to 56 per cent of patients with acute appendicitis showed segmental signs over the right abdominal quadrant, with the maximum located approximately at McBurney’s point [40]. These findings were recently confirmed by Roumen and colleagues, who reported that 39 per cent of patients with acute appendicitis demonstrated at least one segmental sign (hyperalgesia, hypoesthesia, altered cool perception, positive pinch test) over the lower right abdomen [27]. Finally, a large number of smaller studies and case reports have been published, many of them from the osteopathic profession, and have been reviewed by Beal [41].…”

Section: Discussionmentioning

confidence: 88%

“…Closely related but much less known phenomena in acute visceral diseases are segmental signs and symptoms [12-27]. Here, pain signals from visceral organs are referred to other somatic or visceral tissues with overlapping segmental innervation.…”

Section: Introductionmentioning

confidence: 99%

Segmental Signs and Spontaneous Pain in Acute Visceral Disease - Lateralization and Bodily Patterns

Shaballout

Aloumar

Manuel

et al. 2020

Preprint

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The differential diagnosis of acute visceral diseases is a challenging clinical problem. The older literature suggests that patients with acute visceral problems show segmental signs, such as hyperalgesia, skin resistance, or muscular defence, whose lateralization and segmental distribution may be used for differential diagnosis. This study aimed to investigate the lateralization and segmental distribution of spontaneous pain and segmental signs in acute visceral diseases. We recruited 208 emergency room patients that were presenting for acute medical problems. All patients underwent a structured 10-minute bodily examination to test for various segmental signs and were asked for spontaneous pain and segmental symptoms, such as nausea, meteorism, and urinary retention. We collected all findings as digital drawings on a tablet-PC. After the final diagnosis, patients were divided into groups according to the organ affected. Using statistical image analysis, we calculated average distributions of pain and segmental signs for the heart, lungs, stomach, liver/gallbladder, and kidneys/ureters analyzing their segmental distribution and lateralization. 85 of 110 patients with a single-organ problem reported pain, while 81 had at least one segmental sign, the most frequent being hyperalgesia (n=46), and muscle resistance (n=39). While the pain was distributed along the body midline, segmental signs for the heart, stomach and liver/gallbladder appeared mostly ipsilateral to the affected organ. An unexpectedly high number of patients (n=37) further showed ipsilateral mydriasis. The present study underlines the usefulness of including segmental signs in the bodily examination of patients with acute medical problems.

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“…An alternative reason for concomitant visceral symptoms in patients with AWP is the segmental relationship between affected intercostal nerves and internal organs via splanchnic chains. 16 A common feature of AWP is that pain may be so sharply localized and most tender over a small area of the abdominal wall (less than 2 cm in diameter), which the patient indicates by pointing and a fingertip covering the entire area. This almost always indicates that the pain originates in the abdominal wall; visceral pain cannot be so precisely localized because of the wide spinal cord overlap of the viscerosensory representation.…”

Section: Clinical Featuresmentioning

confidence: 99%

Abdominal Wall Pain: A Common Clinical Problem

Sweetser

2019

Mayo Clinic Proceedings

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Acute Appendicitis, Somatosensory Disturbances (“Head Zones”), and the Differential Diagnosis of Anterior Cutaneous Nerve Entrapment Syndrome (ACNES)

Cited by 15 publications

References 10 publications

Lateralization and Bodily Patterns of Segmental Signs and Spontaneous Pain in Acute Visceral Disease: Observational Study

Lateralization and Bodily Patterns of Segmental Signs and Spontaneous Pain in Acute Visceral Disease: Observational Study

Segmental Signs and Spontaneous Pain in Acute Visceral Disease - Lateralization and Bodily Patterns

Abdominal Wall Pain: A Common Clinical Problem

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