Surgery for refractory anterior cutaneous nerve entrapment syndrome (ACNES) in children

• Published in: Journal of pediatric surgery Vol. 46; no. 4; pp. 699 - 703
• Main Authors: Scheltinga, Marc R., Boelens, Oliver B., Tjon A Ten, Walther E., Roumen, Rudi M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2011
• Subjects: Abdominal Muscles - innervation; Abdominal Pain - diagnosis; Abdominal Pain - etiology; Abdominal Pain - surgery; ACNES; Adolescent; Anterior cutaneous nerve entrapment; Child; Chronic Disease; Humans; Nerve Compression Syndromes - complications; Nerve Compression Syndromes - diagnosis; Nerve Compression Syndromes - surgery; Neurosurgical Procedures - methods; Pain Measurement; Pediatrics; Peripheral Nerves - surgery; Quality of Life; Recurrent abdominal pain; Skin - innervation; Surgery; Surveys and Questionnaires; Anterior cutaneous nerve entrapment; Recurrent abdominal pain; ACNES
• ISSN: 0022-3468; 1531-5037; 1531-5037
• DOI: 10.1016/j.jpedsurg.2010.08.054

Chronic abdominal pain (CAP) in children may be caused by entrapment of cutaneous branches of intercostal nerves (anterior cutaneous nerve entrapment syndrome, or ACNES). Local injection of anesthetics may offer relief, but pain is persistent in some children. This study is the first to describe the results of a ‘cutaneous neurectomy’ in children with refractory ACNES. Chronic abdominal pain children with suspected ACNES refractory to conservative treatment received a cutaneous neurectomy in a day care setting. They were interviewed postoperatively using an adapted quality of life questionnaire (testing quality of life in children). All subjects (n = 6; median age, 15 years; range, 9-16 years) were previously healthy school-aged children without prior illness or earlier surgery. Each presented with intense abdominal pain and a positive Carnett sign. Blood, urine tests, and abdominal ultrasound investigations were normal. Delay in seeing a physician was 16 weeks, and school absence was 25 days. Before surgery, quality of life (pain, daily activities, and sports) was greatly diminished. After the neurectomy, all children were free of pain and had resumed their normal daily routine (follow-up at 6 months). The role of the abdominal wall as the source of childhood CAP is underestimated. Some children with CAP have ACNES. Children with refractory ACNES should be offered a cutaneous neurectomy, as this simple technique is effective in the short and long term.