2023 Volume 59 Issue 4 Pages 778-783
Anterior cutaneous nerve strangulation syndrome (ACNES) is a disorder in which the anterior cutaneous branch of the intercostal nerve is injured in the anterior sheath of the rectus abdominis muscle, causing pain at the outer edge of the rectus abdominis muscle. Moreover, it may also include pain arising from other cutaneous nerves throughout the abdominal wall. In this study, we report two atypical cases of ACNES treated surgically. In case 1, a 12-year-old girl complained of chronic abdominal wall pain in the right inguinal region. In case 2, a 15-year-old boy complained of left-sided abdominal pain. Conservative treatment was temporarily effective, and surgery was performed 8 months and 2 years and 4 months after the onset in cases 1 and 2, respectively. In case 1, the inguinal canal was opened and the ilioinguinal nerve was identified for neurectomy. In case 2, a preoperative trigger point injection with indigo carmine dye was used to identify and resect the iliohypogastric nerve behind the transversus abdominis tendon membrane. In both cases, symptoms resolved after surgery. Neurectomy may be effective in atypical ACNES patients who do not respond to conservative treatment, and a treatment strategy needs to be established.
