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      Síndrome de ACNES: no todo dolor abdominal es visceral Translated title: ACNES syndrome, not all abdominal pain is visceral

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          Abstract

          Resumen El anterior cutaneous nerve entrapment syndrome (ACNES) es un tipo de dolor abdominal crónico originado en la pared abdominal. Su diagnóstico inicialmente es clínico, basado en historia clínica y exploración física compatibles, con signos de Carnett, pinch test o disestesias positivos. El diagnóstico definitivo se realiza a través de la mejoría clínica tras infiltración con anestésico tópico en el punto de máximo dolor. Este síndrome es poco conocido y por consiguiente infradiagnosticado, suponiendo un exceso de pruebas complementarias innecesarias e invasivas.

          Translated abstract

          Abstract The anterior cutaneous nerve entrapment syndrome (ACNES) is a type of chronic neuropathic pain felt in the abdominal wall. Initially, its diagnosis is clinical, based on a compatible clinical history and physical examination, with Carnett signs, Pinch test and/or positive dysesthesias. The definitive diagnosis is made through clinical improvement after infiltration with topical anesthetic at the point of maximum pain. This syndrome is frequently overlooked and therefore underdiagnosed, involving an excess of unnecessary and invasive complementary tests.

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          Management of anterior cutaneous nerve entrapment syndrome in a cohort of 139 patients.

          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. 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 trigger point followed by subsequent therapeutic injections including corticosteroids. If pain was refractory, an anterior neurectomy was performed. Pain scores were done using a visual analog scale for evaluation of the injection regimen and Verbal Rating Scale (1-5) for long-term efficacy. A total of 139 patients with suspected ACNES (77% women, mean age 47 ± 17 years) were evaluated. Eighty-one percent (n = 94) demonstrated a visual analog scale reduction of at least 50% after the first injection. Some 33% (n = 44) remained permanently pain-free after injection therapy only. Sixty-nine patients underwent a neurectomy, which was successful in 49 (71%). Long-term efficacy revealed in 71% (very) satisfying visual rating scale (1-2) results, whereas an additional 9% reported attenuated levels of pain (visual rating scale 3). A regimen of consecutive local trigger point injections is effective in one-thirds of patients with ACNES. Surgical neurectomy is effective in about two-thirds of the injection regimen refractory patients. Eighty percent of the entire ACNES population reports total or substantial pain relief on the long term.
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            Intercostal neuralgia as a cause of abdominal pain and tenderness

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              Anterior cutaneous nerve entrapment syndrome (ACNES).

              The abdominal wall is frequently overlooked as a potential source of chronic abdominal pain. In anterior cutaneous nerve entrapment syndrome (ACNES), irritated intercostal nerves cause severe abdominal pain. Current textbooks fail to acknowledge ACNES. Aim of the present review is to provide detailed information on patient history, physical examination, and a three-step treatment protocol including abdominal wall injections and a localized removal of terminal branches of intercostal nerves.
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                Author and article information

                Journal
                pap
                Pediatría Atención Primaria
                Rev Pediatr Aten Primaria
                Asociación Española de Pediatría de Atención Primaria (Madrid, Madrid, Spain )
                1139-7632
                March 2021
                : 23
                : 89
                : e17-e21
                Affiliations
                [2] Madrid orgnameHospital Universitario 12 de Octubre orgdiv1Servicio de Pediatría orgdiv2Sección de Gastroenterología, Hepatología y Nutrición Pediátrica España
                [1] Madrid orgnameHospital Universitario Fundación Alcorcón orgdiv1Servicio de Pediatría España
                Article
                S1139-76322021000100017 S1139-7632(21)02308900017
                177658dd-975d-4856-a633-9ae59c628a69

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 17, Pages: 0
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                SciELO Spain

                Categories
                Casos clínicos en Digestivo

                Abdominal pain,Dolor abdominal
                Abdominal pain, Dolor abdominal

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