Anterior Cutaneous Nerve Entrapment — A Cause of Abdominal Wall Pain

Clinicians often overlook the abdominal wall as a source of chronic abdominal pain. One entity described in the medical literature is “anterior cutaneous nerve entrapment syndrome” (ACNES), in which the end twigs of cutaneous intercostal nerves are entrapped as they penetrate along the lateral border of the rectus abdominis muscle. ACNES is tentatively diagnosed if a patient has a discrete tender area along the lateral rectus abdominis and increased tenderness during abdominal-wall tensing maneuvers (Carnett's sign). Dutch surgeons have addressed ACNES in two studies.

In an observational cohort study, 135 patients with presumed ACNES underwent diagnostic infiltration with 1% lidocaine; 88% experienced pain relief. Of 56 patients who later un…