Diagnostic dilemma: think about anterior cutaneous nerve entrapment syndrome (ACNES) in patients with atypical abdominal pain and Crohn’s disease

Abstract

Chronic abdominal pain can be a difficult diagnostic dilemma. Anterior cutaneous nerve entrapment syndrome (ACNES) is a potential differential diagnosis that should be considered because treatment is both easy and effective. We describe the case of a 51-year-old man presenting with 7 months of right lower quadrant abdominal pain on the background of known Crohn's disease. A circumspect surgical approach and multidisciplinary input was key to making the diagnosis of a nerve entrapment syndrome.

Anterior Cutaneous Nerve Entrapment Syndrome Occurring after Endoscopy

“…In our case, the patient had two distinct causes of epigastric pain. This can make the diagnosis of ACNES a greater hurdle, as experienced by Lam and Vasey [13] in a case of ACNES arising in a Crohn’s disease patient. Given the patient’s history of somatoform disorder, psychogenic abdominal pain and functional dyspepsia were also in our differential.…”