A Case of Difficult Diagnosis for Chronic Abdominal Wall Pain : Abdominal Cutaneous Nerve Entrapment Syndrome (ACNES) Long-Term After the Definitive Operation for Cloacal Anomaly

Abstract

Chronic abdominal pain is a common complaint in children. Pain originating from the abdominal wall is a relatively unknown and often overlooked cause, although it may account for about 10-30% of patients with chronic abdominal pain. Sharply localized pain and superficial tenderness are suggestive of chronic abdominal wall pain. The most common cause of chronic abdominal wall pain appears to be abdominal cutaneous nerve entrapment syndrome (ACNES). Carnett's test (accentuated localized tenderness with abdominal wall tensing) is a helpful diagnostic sign. In this report, we describe a 7-year-old girl with ACNES long-term after an operation for cloacal anomaly. As a result, an anesthetic/corticosteroid local injection gave complete pain relief for prolonged periods. However, we expended a lot of time and cost for this difficult diagnosis because we had no concept of this disease. For the clinical care of chronic abdominal pain, it appears to be necessary to take abdominal wall pain into consideration.