Anterior neurectomy in children with a recalcitrant anterior cutaneous nerve entrapment syndrome is safe and successful

Anterior cutaneous nerve entrapment syndrome: management challenges

“…Siawash et al6 administered a freehand injection to 95 adolescents with chronic abdominal pain for a diagnostic purpose. ACNES was diagnosed only in 12 subjects, who exhibited >50% pain relief after receiving the injection of l% lidocaine.…”

“…Another case report of a 13-year-old patient was described by Triantafyllidis et al25 In this patient, surgical neurectomy resulted in a desirable effect. Recently, Siawash et al6 published a prospective study of anterior neurectomy in 60 children suffering from ACNES refractory to other treatments. The children were initially treated with a modified rectus sheath block using lidocaine and methylprednisolone.…”

“…In this syndrome, the cutaneous branches of the lower thoracoabdominal intercostal nerves are entrapped at the lateral border of the rectus abdominis muscle, resulting in a severe, often refractory, chronic pain 1. The prevalence of the syndrome ranges between 15% and 30% depending on the definition and the diagnostic criteria used 2–6. In adolescents, it is reported to be diagnosed in one out of eight cases of chronic abdominal pain 3,7.…”

“…Anatomically, the lower intercostal nerves (T8–T12) run between the internal oblique and transversus abdominis muscles, up to the point where they reach the rectus abdominis; here, they make a turn in their course to enter the rectus channels (commonly five at each abdominal side) 5,6. Some authors have suggested that the entrapment is usually caused by this sudden turn in their course into the rectus abdominis channel, leading to ACNES 1,7.…”

“…Studies suggest4,6,7,10,11,14,19–20 some specific diagnostic steps to diagnose ACNES, and these include: Unilateral locoregional pain at the abdominal wall lasting for at least 1 monthThe presence of a unilateral tender spot at the abdominal wall (a trigger point of <2 cm 2 fingertip area of maximal tenderness, localized at the lateral border of the rectus abdominis)A positive Carnett’s testA positive skin pinch test and/or altered skin perception to light touch and/or cold at the area of the most intense painNormal laboratory findings with no indication of inflammation or infection, and in the absence of any surgical cause of painNegative imaging of the abdominal wallTemporary positive relief in pain response of at least by 50% after injecting a local anesthetic (usually lidocaine) at the diagnostic trigger point.…”