Chronic Abdominal Wall Pain Misdiagnosed as Functional Abdominal Pain

• Published in: Journal of the American Board of Family Medicine Vol. 26; no. 6; pp. 738 - 744
• Main Authors: van Assen, T., de Jager-Kievit, J. W. A. J., Scheltinga, M. R., Roumen, R. M. H.
• Format: Journal Article
• Language: English
• Published: United States 01.11.2013
• Subjects: Abdominal Pain - diagnosis; Abdominal Pain - epidemiology; Abdominal Wall - innervation; Chronic Pain - diagnosis; Chronic Pain - epidemiology; Cross-Sectional Studies; Diagnosis, Differential; Diagnostic Errors; Female; Humans; Incidence; Male; Middle Aged; Nerve Compression Syndromes - diagnosis; Nerve Compression Syndromes - epidemiology; Netherlands - epidemiology; Physicians, Primary Care; Prevalence; Surveys and Questionnaires; Netherlands; Prevalence Studies; Abdominal Pain; Irritable Bowel Syndrome; Anterior Cutaneous Nerve Entrapment Syndrome; Chronic Pain
• ISSN: 1557-2625; 1558-7118; 1558-7118
• DOI: 10.3122/jabfm.2013.06.130115

The abdominal wall is often neglected as a cause of chronic abdominal pain. The aim of this study was to identify chronic abdominal wall pain syndromes, such as anterior cutaneous nerve entrapment syndrome (ACNES), in a patient population diagnosed with functional abdominal pain, including irritable bowel syndrome, using a validated 18-item questionnaire as an identification tool. In this cross-sectional analysis, 4 Dutch primary care practices employing physicians who were unaware of the existence of ACNES were selected. A total of 535 patients ≥18 years old who were registered with a functional abdominal pain diagnosis were approached when they were symptomatic to complete the questionnaire (maximum 18 points). Responders who scored at least the 10-point cutoff value (sensitivity, 0.94; specificity, 0.92) underwent a diagnostic evaluation to establish their final diagnosis. The main outcome was the presence and prevalence of ACNES in a group of symptomatic patients diagnosed with functional abdominal pain. Of 535 patients, 304 (57%) responded; 167 subjects (31%) recently reporting symptoms completed the questionnaire. Of 23 patients who scored above the 10-point cutoff value, 18 were available for a diagnostic evaluation. In half of these subjects (n = 9) functional abdominal pain (including IBS) was confirmed. However, the other 9 patients were suffering from abdominal wall pain syndrome, 6 of whom were diagnosed with ACNES (3.6% prevalence rate of symptomatic subjects; 95% confidence interval, 1.7-7.6), whereas the remaining 3 harbored a painful lipoma, an abdominal herniation, and a painful scar. A clinically relevant portion of patients previously diagnosed with functional abdominal pain syndrome in a primary care environment suffers from an abdominal wall pain syndrome such as ACNES.