Two cases of anterior cutaneous nerve entrapment syndrome after abdominal surgery were successfully treated by ultrasound-guided block therapy

Abstract

Anterior cutaneous nerve entrapment syndrome (ACNES) is one of the causes of abdominal pain. We report that ultrasound-guided blocks were effective for cases in which ACNES developed 10 days after laparoscopic surgery and six years after laparotomy. Both cases showed normal laboratory and imaging findings. Carnett's sign was positive in both cases. The first case was an 81-year-old woman who underwent laparoscopic pyloric gastrectomy for gastric cancer. Ten days after surgery, tenderness was observed in the sutured parts after drain removal. An ultrasound-guided rectus sheath block was applied three times to treat the pain. The second case was a 53-year-old man who underwent laparotomy for perforated appendicitis. Six years after the operation, tenderness appeared on the sutured parts when abdominal pressure was applied. Exploratory laparoscopy was performed but the cause of the pain could not be determined, and ACNES was considered. Repeated ultrasound-guided rectus sheath blocks and transversus abdominis plane blocks were applied to treat the pain.