The Abdominal ACNES Syndrome
The Abdominal ACNES Syndrome Abdominal ACNES syndrome, or Anterior Cutaneous Nerve Entrapment Syndrome, is an often-overlooked cause of chronic abdominal pain. Despite being relatively common, it remains underdiagnosed due to its nonspecific symptoms and the tendency for healthcare providers to pursue extensive investigations for other gastrointestinal or intra-abdominal conditions. Understanding ACNES is crucial for both clinicians and patients to ensure accurate diagnosis and effective management.
The Abdominal ACNES Syndrome The syndrome originates from the entrapment or irritation of the anterior cutaneous branches of the lower thoracic nerves, typically T7 to T12. These nerves pass through the abdominal muscles and fascia, and when they become compressed or irritated—often due to muscle strain, trauma, or post-surgical changes—they can produce localized pain. The pain associated with ACNES is usually sharp or stabbing, often localized to a small area on the abdomen, and may be persistent or intermittent.
One of the key features of ACNES is its subtle clinical presentation. Patients often report pain that is well localized, often in the lateral or lower abdominal region, and may be worsened by movement, coughing, or palpation. A characteristic sign is a positive Carnett’s test, where abdominal pain intensifies or remains unchanged when the abdominal muscles are tensed, helping distinguish nerve entrapment from other intra-abdominal pathologies. Additionally, the point of maximal tenderness is usually found over the lateral rectus or rectus abdominis muscles. The Abdominal ACNES Syndrome
Diagnosing ACNES requires a high degree of clinical suspicion, as it mimics other causes of abdominal pain such as appendicitis, ovarian cysts, or gastrointestinal disorders. Laboratory tests and imaging studies often return normal results, leading to frustration for both patient and
clinician. The definitive diagnostic tool is often an initial local anesthetic injection at the tender point. If the pain temporarily subsides following the injection, this strongly suggests ACNES as the source. The Abdominal ACNES Syndrome
Management of ACNES primarily involves targeted nerve blocks, which can provide significant pain relief. In many cases, patients experience sustained improvement after repeated nerve blocks. For those with persistent symptoms, more invasive procedures such as trigger point injections or even surgical nerve entrapment release may be considered. Physical therapy focusing on core strengthening and posture correction can also be beneficial, especially in cases related to muscular strain. The Abdominal ACNES Syndrome
Awareness of ACNES among healthcare providers is essential because timely diagnosis can prevent unnecessary tests and surgeries, reducing patient suffering and healthcare costs. Patients should be encouraged to communicate detailed descriptions of their pain and to inquire about nerve-related causes when conventional investigations are inconclusive.
In summary, abdominal ACNES syndrome is a common but often underrecognized cause of chronic abdominal pain. Proper clinical assessment, including specific physical examination maneuvers and diagnostic nerve blocks, can lead to effective treatment. Recognizing this syndrome can significantly improve patient quality of life by providing targeted relief and avoiding unnecessary interventions. The Abdominal ACNES Syndrome
