Diagnostic Usefulness of Carnett's Test in Psychogenic Abdominal Pain

Takada, Toshihiko; Ikusaka, Masatomi; Ohira, Yoshiyuki; Noda, Kazutaka; Tsukamoto, Tomoko

doi:10.2169/internalmedicine.50.4179

Cited by 43 publications

(28 citation statements)

References 23 publications

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“…Ocasionalmente sobre el sitio del dolor hay alodinia (sensación dolorosa anormal al tacto, que es un estímulo que normalmente no produce dolor) (1). Cuando el punto doloroso se identifica con las característi-cas mencionadas, la positividad del mismo tiene sensibilidad y especificidad del 88% y del 97%, respectivamente (12).…”

Section: Discussionunclassified

El costo de ignorar el signo de Carnett. Reporte de caso y revisión de la literatura

Regino

Rodríguez

Mindiola

2017

Rev. Colomb. Gastroenterol.

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ResumenEl dolor abdominal crónico es un motivo frecuente de consulta externa y de urgencias. Los médicos tradicionalmente consideran que el origen del mismo son las estructuras intraabdominales, incluido el tracto gastrointestinal. Rara vez tienen en cuenta la pared abdominal como la causa de la molestia y someten a los pacientes a numerosos e interminables procedimientos diagnósticos, como laparoscopias y cirugías, entre otros. Por lo menos el 50% de estos pacientes tiene dolor de la pared abdominal por lesión del nervio cutáneo anterior y el diagnóstico se hace identificando el signo de Carnett. Se presenta un caso típico con esta patología, cuyo enfoque inicial ilustra los errores y altos costos en el abordaje de esta patología. Palabras claveDolor abdominal crónico, nervio cutáneo anterior, signo de Carnett, costos. AbstractChronic abdominal pain is a frequent cause of outpatient and emergency visits. Doctors traditionally consider that its origin is in intra-abdominal structures, including the gastrointestinal tract. They rarely take into account the abdominal wall as a cause of discomfort and subject patients to numerous and endless diagnostic procedures, including laparoscopy and surgery. At least 50% of these patients have abdominal wall pain due to injuries to the anterior cutaneous vein the diagnosis of which is made by identifying Carnett's sign. A typical case of this pathology is here. The initial approach illustrates the errors and high costs that can be involved in the approach to this pathology. Key wordsChronic abdominal pain, anterior cutaneous nerve, Carnett's sign, costs. Reporte de casos INTRODUCCIÓNEl dolor abdominal crónico tiene múltiples causas y en la práctica médica es un desafío para los médicos de cuidado primario, los especialistas y los profesionales de los hospitales de referencia (1-3). En gastroenterología, el 50% de los pacientes tiene un dolor idiopático y en el 10%-90% de ellos se observa que el origen del mismo está en la estructuras de la pared abdominal. En cuanto a estas, la lesión o compresión del nervio cutáneo anterior es la etiología más frecuente (2-5). Sin embargo, los médicos usualmente consideran que la causa del mismo son las vísceras abdominales y rara vez piensan en la posibilidad de estudiar la pared abdominal (1, 3, 5). Después de investigar las causas viscerales, los pacientes terminan con diagnóstico de enfermedad sicosomática, síndrome del intestino irritable (SII) o gastritis, entre otros, y reciben tratamiento con analgési-cos, ansiolíticos, antidepresivos o benzodiacepinas, y no es

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Section: Discussionunclassified

El costo de ignorar el signo de Carnett. Reporte de caso y revisión de la literatura

Regino

Rodríguez

Mindiola

2017

Rev. Colomb. Gastroenterol.

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“…These patients often go to the doctor and doing unnecessary tests, thus wasting time and spending money. Many authors have previously thought that the cause of chronic abdominal pain on anterior abdominal wall trauma or a consequence of surgery (9, 10). In our research, we realized that ACNES may be without previous traumatic event.…”

Section: Discussionmentioning

confidence: 99%

“…Mechanical irritation causes localized swelling that may injure the nerve directly or compromise the nerve’s circulation. Tenderness of the main nerve trunk sometimes may be found proximal or distal to the affected portion (9). The thoracoabdominal nerves, which terminate as cutaneous nerves, are anchored in the rectus channel and in the skin.…”

Section: Introductionmentioning

confidence: 99%

Surgery for Abdominal Wall Pain Caused by Cutaneous Nerve Entrapment in Children-A Single Institution Experience in the Last 5 Years

Žganjer¹,

Bojić²,

Bumči³

2013

Iran Red Crescent Med J

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BackgroundChronic abdominal pain (CAP) is a serious medical condition which needs to be approached with great attention. Chronic abdominal pain may be caused by entrapment of cutaneous branches of intercostal nerves (ACNES).ObjectivesThe aim of this study is the surgery for abdominal wall pain which caused by cutaneous nerve entrapment in children during last 5 years.Materials and MethodsIn all children with ACNES, we tried conservative treatment with anesthetic and steroid injections. In children who were refractory to conservative treatment, we received surgical procedure like sectioning the entrapped nerve to obtain relief.ResultsIn 12 pediatric patients with chronic abdominal pain, we diagnosed ACNES. Each presented with abdominal pain and a positive Carnett sign. Local nerve blocks using anesthetic and steroid injections are the treatment. In all patients, we tried with local nerve block. In 3 patients, pain improvement occurs in the few minutes, and they were without pain after 5 days. In other 4 patients required a reinjection for pain recurrence. In one patients pain was gone. The maximum reinjection was 3. In other 5 patients, we did operative treatment like sectioning the entrapped nerve.ConclusionsSome children with CAP have ACNES. In all children with ACNES, we recommended local nerve blocks. If the local block in 3 times is not helping, neurectomy of the peripheral nerve is method of choice.

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“…[23][24][25][26][27][28][29][30][31][32][33][34] In a recent health technology assessment 36 the use of a diagnostic tool seems useful to confirm the diagnosis of acute appendicitis, but not to exclude it.…”

Section: For the Purpose Of Abdominal Pain Stratification What Is Thementioning

confidence: 99%

Abdominal pain: a synthesis of recommendations for its correct management

Tirotta

Marchetti²,

Lillo

et al. 2015

Ital J Med

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Abdominal pain represents one of the most important diagnostic challenges for any physician and its correct interpretation and management require a proper systematic approach and sometimes an urgent action. Moreover the guidelines that can be referred to for indications about the most adequate management procedures are few and often focused only on radiologic management. Consequently, the approach to abdominal pain is often empirical. Therefore, we propose a review of the literature on the diagnosis of abdominal pain, which may contribute to improve the diagnosis and treatment of this complex condition through a systematic review of the evidences available in this field. As to our methodology, we conducted an extensive search in the main guideline databases (SIGN, ICSI, NICE, National Guideline Cleringhouse, CMA Infobase, NZ Guidelines Group, National System Guidelines, Clinical Practice Guidelines Portal, eGuidelines), using as key words abdominal pain and abdominalgia. The guidelines were assessed according to the 2010 Italian version of the AGREE (Appraisal of Guidelines, Research and Evaluation II) methodology. Afterwards we formulated our main recommendations associated with the corresponding levels of evidence and focused our attention on some grey areas, which we investigated with further research using Medline and the main systematic review databases (Cochrane database). The four main grey areas investigated were: hospital admission criteria, prognostic stratification, need for analgesic treatment and possibility of attributing abdominalgia to an abdominal pain syndrome. We then formulated our consesus-based recommendations on the grey areas. Abdominal pain management remains a complex issue for internists. As with other diagnostic challenges, it would be advisable to develop additional guidelines based on a multidisciplinary approach and not only focused on radiological management.

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Diagnostic Usefulness of Carnett's Test in Psychogenic Abdominal Pain

Cited by 43 publications

References 23 publications

El costo de ignorar el signo de Carnett. Reporte de caso y revisión de la literatura

El costo de ignorar el signo de Carnett. Reporte de caso y revisión de la literatura

Surgery for Abdominal Wall Pain Caused by Cutaneous Nerve Entrapment in Children-A Single Institution Experience in the Last 5 Years

Abdominal pain: a synthesis of recommendations for its correct management

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