Anterior Cutaneous Nerve Entrapment Syndrome Occurring after Endoscopy

A 45-year-old lady presented for a follow-up endoscopy examination for mild abdominal pain due to gastric ulcers. She experienced a severe, markedly different type of pain with labor-like contractions 3 days later. Physical examination revealed tenderness confined to a 1 × 1-cm area and positive Carnett’s sign. The pain completely resolved 10 min after a subcutaneous lidocaine injection. The patient was diagnosed with anterior cutaneous nerve entrapment syndrome. The pain returned within several hours and anterior neurectomy was performed several days later. The pain subsided immediately and no recurrence was seen during 3 years of follow-up.

Postoperative Abdominal Wall Pain

Abdominal pain accounts for almost 1.5% of office visits and nearly 5% of emergency department admissions each year in the United States. In 2% to 3% of patients with chronic abdominal pain, the pain arises from the abdominal wall. Postoperative abdominal wall pain is chronic, unremitting pain unaffected by eating or bowel function but exacerbated by postural change. A localized, tender trigger point can be identified, although pain may radiate over a diffuse area of the abdomen. Thorough history and physical examination can distinguish abdominal wall pain from visceral intra-abdominal pain. A positive Carnett’s sign favors an abdominal wall pain generator and not a visceral source. Injection with a local anesthetic and steroid at the area of pain may provide relief and can function also as a diagnostic test for abdominal wall pain. Refractory pain may be treated with chemical neurolysis, radiofrequency ablation, peripheral nerve stimulators, or neurectomy.