A Difficult-To-Diagnose Case of Bilateral Anterior Cutaneous Nerve Entrapment Syndrome Presenting With Left and Right Abdominal Pain

Abstract

Anterior cutaneous nerve entrapment syndrome (ACNES) accounts for approximately 13% of chronic abdominal pain in patients aged 10–18 years; however, awareness of this disease is lacking. Surgical outcomes for bilateral ACNES may be poorer than those for unilateral ACNES, often necessitating additional treatment. Here, we report a successful neurectomy in a difficult-to-diagnose case of bilateral ACNES. A 12-year-old girl had suffered abdominal pain in the umbilical region for four months and was referred to our department. No abnormalities were found in blood or imaging tests, and conservative treatment was ineffective. The patient was diagnosed with ACNES on the basis of a positive Carnett’s sign and temporary pain relief with trigger point injections. We performed a neurectomy at the anterior and posterior levels of the rectus abdominis muscle, and the pain resolved immediately after surgery. In patients with bilateral ACNES, neurectomy at the anterior and posterior levels of the rectus abdominis muscle may enhance the likelihood of achieving a complete cure.