Anterior Cutaneous Nerve Entrapment Syndrome Possibly Triggered by Oral Contraceptives.

Published on May 15, 2019in Internal Medicine1.005
· DOI :10.2169/INTERNALMEDICINE.1361-18
Daisuke Omura2
Estimated H-index: 2
(Okayama University),
Mikako Obika5
Estimated H-index: 5
(Okayama University)
+ 5 AuthorsFumio Otsuka35
Estimated H-index: 35
(Okayama University)
: We herein report a teenage girl who had been taking oral contraceptive pills for three months and complained of left lower abdominal pain that had continued for two months. A physical examination indicated anterior cutaneous nerve entrapment syndrome (ACNES), although no abnormality was found in various biochemical and imaging examinations. The pain was only transiently ameliorated by trigger-point injection, and neurectomy surgery was eventually effective. Sex steroids can be involved in the progress of local tissue edema causing ACNES. ACNES should be considered in cases of abdominal pain in patients taking oral contraceptives.
#1Bernhard Dauser (St John of God Health Care)H-Index: 7
#2S. Ghaffari (St John of God Health Care)H-Index: 3
Last. Friedrich Herbst (St John of God Health Care)H-Index: 27
view all 6 authors...
PURPOSE Open anterior release of the external oblique fascia to enable midline closure of large abdominal wall defects is associated with relevant morbidity due to extensive subcutaneous dissection. Using endoscopic techniques, wound complications can be minimized. However, identification of the correct entry point (e.g. for balloon trocar insertion) can be challenging especially in adipose patients. We therefore present a technical modification facilitating the entire procedure. METHODS A novel...
5 CitationsSource
Background Chronic abdominal wall pain is a poorly recognized clinical problem despite being an important element in the differential diagnosis of abdominal pain.
29 CitationsSource
#1Debora Kogan-Liberman (Albert Einstein College of Medicine)H-Index: 3
#2Yolanda RivasH-Index: 4
Last. Gitit TomerH-Index: 12
view all 4 authors...
Received September 9, 2014; accepted March 10, 2015. From the Division of Pediatric Gastroenterology and Nutrition, The Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY. Address correspondence and reprint requests to Gitit Tomer, MD, Division of Pediatric Gastroenterology and Nutrition, The Children’s Hospital at Montefiore, 111 East 210th St, Bronx, NY 10467 (e-mail: gitomer@ This article has been developed as a Journal CME Activity by NASPGHAN....
7 CitationsSource
#1Samira AkhnikhH-Index: 1
#2Niels de KorteH-Index: 2
Last. Peter de WinterH-Index: 2
view all 3 authors...
The abdominal wall is an often overlooked source of pain in children with chronic abdominal pain. For example, abdominal wall pain can be caused by the abdominal cutaneous nerve entrapment syndrome (ACNES). ACNES occurs in children as well as adults. In pediatrics, this diagnosis is largely unknown. ACNES is characterized by a sharp stabbing pain which characteristically increases with the use of abdominal muscles (Carnett’s sign). The pain is usually located in the lower right quadrant. Very of...
26 CitationsSource
#1Oliver B. BoelensH-Index: 8
#2Tijmen van AssenH-Index: 5
Last. Rudi M. H. RoumenH-Index: 32
view all 5 authors...
OBJECTIVE: To clarify the role of a surgical neurectomy on pain in refractory patients after conservatively treated anterior cutaneous nerve entrapment syndrome (ACNES). BACKGROUND: ACNES is hardly ever considered in the differential diagnosis of chronic abdominal pain. Treatment is usually conservative. However, symptoms are often recalcitrant. METHODS: Patients older than 18 years with a diagnosis of ACNES were randomized to undergo a neurectomy or a sham procedure via an open surgical procedu...
66 CitationsSource
#1Oliver B. BoelensH-Index: 8
#2Marc R. ScheltingaH-Index: 27
Last. Rudi M. H. RoumenH-Index: 32
view all 4 authors...
Objective: Anterior cutaneous nerve entrapment syndrome (ACNES) is generally neglected as a source of chronic abdominal pain. The aim of this study was to evaluate the efficacy of a diagnostic workup protocol and treatment regimen in patients with suspected ACNES. Methods: A cohort of all consecutive patients presenting with chronic abdominal pain suggestive of ACNES between 2003 and 2008 was evaluated retrospectively. Patients were offered a single diagnostic injection of 1% lidocaine into the ...
75 CitationsSource
Abstract Background Chronic abdominal wall pain (CAWP) occurs in about 30% of all patients presenting with chronic abdominal pain. Methods The authors review the literature identified in a PubMed search regarding the abdominal wall as the origin of chronic abdominal pain. Results CAWP is frequently misinterpreted as visceral or functional abdominal pain. Misdiagnosis often leads to a variety of investigational procedures and even abdominal operations with negative results. With a simple clinical...
82 CitationsSource
#1Christine G. Lee (University of Washington Medical Center)H-Index: 1
#1Christine G. Lee (University of Washington Medical Center)H-Index: 1
Last. John D. Brunzell (University of Washington Medical Center)H-Index: 3
view all 9 authors...
Context: Postmenopausal women have greater visceral adiposity compared with premenopausal women. Adipokines are associated with increased adiposity, insulin resistance, and atherosclerosis. Objective: The objective of the study was to assess changes in adipokines and inflammatory markers through the menopausal transition and correlate them with changes in visceral adiposity. Design and Setting: This was a prospective cohort study of women through the menopausal transition conducted at the Univer...
182 CitationsSource
#1Deborah J. Clegg (UC: University of Cincinnati)H-Index: 69
#2Lynda M. BrownH-Index: 10
Last. Stephen C. BenoitH-Index: 64
view all 4 authors...
Males have proportionally more visceral fat and are more likely to develop complications associated with obesity than females, and the male brain is relatively more sensitive to the catabolic action of insulin and less sensitive to that of leptin than the female brain. To understand the underlying mechanism, we manipulated estrogen through ovariectomy (OVX) and estradiol administration. Rats with relatively high systemic estrogen (intact females and OVX females and males administered estrogen su...
441 CitationsSource
#1Giovanni AlbaniH-Index: 17
#2Lorenzo PrianoH-Index: 20
Last. Alessandro Mauro (UNITO: University of Turin)H-Index: 41
view all 7 authors...
In view of the prevalence of carpal tunnel syndrome (CTS) in females (prevalence 4:1) and other gender-related CTS risk factors (pregnancy and menopause) we hypothesized that hormonal factors could influence the pathogenesis of the syndrome. We thus set out to evaluate the association between the use of oral contraceptive drugs (ORCDs) and CTS as a way to gain insight into the relationship between hormonal factors and CTS. Some data suggest a positive association between ORCDs and CTS (Sabour an...
3 CitationsSource
Cited By1
#1Gregory P. CofanoH-Index: 1
#2Shawn LaCourt (Palmer College of Chiropractic)
view all 3 authors...
Abstract Objective To describe a conservative approach to care of an adult patient presenting with chronic abdominal wall pain persisting two years following abdominal surgery. Clinical features A 62-year-old female presented to a chiropractic neurologist with abdominal wall pain and sensation deficits. Her prior surgical history and a positive Carnett's sign indicated anterior cutaneous nerve entrapment syndrome (ACNES). Intervention and outcome Treatments, including manual therapy, rehabilitat...