Two Pediatric Cases of Anterior Cutaneous Nerve Entrapment Syndrome (ACNES)

Abstract

Anterior cutaneous nerve entrapment syndrome (ACNES) is relatively unknown as a cause of abdominal wall pain, and pediatric cases in Japan are almost never recognized. We reported two cases of ACNES in children. Case 1: A 14-year-old female was referred to our department with right lower quadrant (RLQ) abdominal pain during activity. Blood examination and CT and MRI showed no abnormalities, but Carnett’s test was positive. We performed rectus sheath block for progressive pain, but the pain still persisted. Four months after the consultation, neurectomy was performed. Case 2: A 9-year-old male was referred to our department with a 9-month history of RLQ abdominal pain of unknown cause. Blood and imaging test showed no abnormalities but Carnett’s test was positive; therefore, we suspected ACNES. We performed neurectomy without injection therapy because his family wished only for this operation to be performed. The number of reported cases of ACNES has increased in recent years, and there may be many cases in which it is the cause of chronic abdominal pain. It is important for practitioners to be aware that ACNES may be detected by physical examination in the absence of any abnormal laboratory findings. Although local injection therapy is effective to some extent, neurectomy is a radical and effective treatment.