Abdominal Anterior Cutaneous Nerve Entrapment Syndrome: Case Report of An Overlooked Diagnosis
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Published:
Jun 17, 2025
Keywords:
Anterior Cutaneous Nerve Entrapment Syndrome; Hydrodissection; Ultrasound-guided; Interventional pain management; Carnett’s sign
Main Article Content
Abstract
Introduction: Abdominal Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) is a chronic abdominal pain condition caused by entrapment of thoracoabdominal nerve branches in the abdominal wall. It is often misdiagnosed due to nonspecific symptoms resembling gastrointestinal issues. Hydrodissection, a minimally invasive technique, involves injecting fluid to release entrapped nerves and alleviate pain. This case highlights successful pain relief in ACNES using ultrasound-guided hydrodissection. Methods: A case report of a 27-year-old male pilot presented with chronic lower abdominal pain for five months, worsened by sitting post varicocele operation. The patient reported having persistent abdominal pain with a Numeric Rating Scale (NRS) score of 5–6. Despite undergoing prolotherapy and radiofrequency targeting the left ilioinguinal nerve, the pain intensified to an NRS of 8–9. Examination revealed a positive Carnett’s sign, suggesting ACNES. Hydrodissection with lidocaine under ultrasound guidance was performed. Result: Post-hydrodissection, the patient reported significant pain relief, with his NRS score decreasing from 8–9 to 0–1. He experienced near-complete resolution of chronic abdominal pain without adverse effects, demonstrating hydrodissection's effectiveness. Conclusion: Recognizing ACNES as a potential cause of chronic abdominal pain is essential for targeted intervention.
Article Details
How to Cite
Chandra Tania Novy, T., Hadimartana, D., & Satria Ambara Putra, D. G. (2025). Abdominal Anterior Cutaneous Nerve Entrapment Syndrome: Case Report of An Overlooked Diagnosis. Indonesian Journal of Physical Medicine and Rehabilitation, 14(1), 59 - 66. https://doi.org/10.36803/indojpmr.v14i1.464
Section
Case Report
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References
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2. Chrona E, Kostopanagiotou G, Damigos D, Batistaki C. Anterior cutaneous nerve entrapment syndrome: Management challenges. J Pain Res. 2017;10:145-156. doi:10.2147/JPR.S99337.
3. Clarke S, Kanakarajan S. Abdominal cutaneous nerve entrapment syndrome. Contin Educ Anaesth Crit Care Pain. 2015;15(2):60-63. doi:10.1093/bjaceaccp/mku016.
4. Pratka HW, Martinez M. Anterior cutaneous nerve entrapment syndrome presenting as chronic abdominal pain. Cureus. 2024;16(12):10-12. doi:10.7759/cureus.74921.
5. Mol FM, Maatman RC, De Joode LEGH, Van Eerten P, Scheltinga MR, Roumen R. Characteristics of 1116 consecutive patients diagnosed with anterior cutaneous nerve entrapment syndrome (ACNES). Ann Surg. 2021;273(2):373-378. doi:10.1097/SLA.0000000000003224.
6. Oor JE, Ünlü Ç, Hazebroek EJ. A systematic review of the treatment for abdominal cutaneous nerve entrapment syndrome (ACNES). Am J Surg. 2016;211(1):176-183. doi:10.1016/j.amjsurg.2015.12.013.
7. Lam KHS, Hung CY, Chiang YP, Onishi K, Su DCJ, Clark TB, et al. Ultrasound-guided nerve hydrodissection for pain management: Rationale, methods, current literature, and theoretical mechanisms. J Pain Res. 2020;13:1957-1968. doi:10.2147/JPR.S247208.
8. Jacobs MLYE, van den Dungen-Roelofsen R, Heemskerk J, Scheltinga MRM, Roumen RMH. Ultrasound-guided abdominal wall infiltration versus freehand technique in anterior cutaneous nerve entrapment syndrome (ACNES): Randomized clinical trial. BJS Open. 2021;5(6).
9. Clarke S, Kanakarajan S. Abdominal cutaneous nerve entrapment syndrome. Contin Educ Anaesth Crit Care Pain. 2015;15(2):60-63. doi:10.1093/bjaceaccp/mku016.
10. Van Assen T, Brouns JAGM, Scheltinga MR, Roumen RM. Incidence of abdominal pain due to the anterior cutaneous nerve entrapment syndrome in an emergency department. Scand J Trauma Resusc Emerg Med. 2015;23:19. doi:10.1186/s13049-015-0096-0.
11. Tanizaki R, Takemura Y. Anterior cutaneous nerve entrapment syndrome with pain present only during Carnett’s sign testing: A case report. BMC Res Notes. 2017;10:281. doi:10.1186/s13104-017-2816-1.
12. Smelt H, Pouwels S, Apers JA, Said M, Smulders J. Anterior cutaneous nerve entrapment syndrome: Two case reports of the forgotten diagnosis after bariatric surgery. Cureus. 2020;12(6). doi:10.7759/cureus.8499.
13. Sanchez Galindo B. Chronic abdominal pain due to entrapment of the anterior abdominal cutaneous nerve (ACNES): About a case. J Family Med Prim Care. 2022;11(8):4834-4836. doi:10.4103/jfmpc.jfmpc_228_22.
14. Okamoto T, Fukuda K. Anterior cutaneous nerve entrapment syndrome occurring after endoscopy. Case Rep Gastroenterol. 2020;14(2):377-382. doi:10.1159/000508440.
15. Kedia SK, Sidiq M, Gonnade NM, Banu SB, Prakash CHSJ, Yadav M. Interventional rehabilitation approach in anterior cutaneous nerve entrapment syndrome post nephrectomy: A case report. J Pharm Negat Results. 2023;14(Special Issue 1):697-699. doi:10.47750/pnr.2023.14.S01.95.
2. Chrona E, Kostopanagiotou G, Damigos D, Batistaki C. Anterior cutaneous nerve entrapment syndrome: Management challenges. J Pain Res. 2017;10:145-156. doi:10.2147/JPR.S99337.
3. Clarke S, Kanakarajan S. Abdominal cutaneous nerve entrapment syndrome. Contin Educ Anaesth Crit Care Pain. 2015;15(2):60-63. doi:10.1093/bjaceaccp/mku016.
4. Pratka HW, Martinez M. Anterior cutaneous nerve entrapment syndrome presenting as chronic abdominal pain. Cureus. 2024;16(12):10-12. doi:10.7759/cureus.74921.
5. Mol FM, Maatman RC, De Joode LEGH, Van Eerten P, Scheltinga MR, Roumen R. Characteristics of 1116 consecutive patients diagnosed with anterior cutaneous nerve entrapment syndrome (ACNES). Ann Surg. 2021;273(2):373-378. doi:10.1097/SLA.0000000000003224.
6. Oor JE, Ünlü Ç, Hazebroek EJ. A systematic review of the treatment for abdominal cutaneous nerve entrapment syndrome (ACNES). Am J Surg. 2016;211(1):176-183. doi:10.1016/j.amjsurg.2015.12.013.
7. Lam KHS, Hung CY, Chiang YP, Onishi K, Su DCJ, Clark TB, et al. Ultrasound-guided nerve hydrodissection for pain management: Rationale, methods, current literature, and theoretical mechanisms. J Pain Res. 2020;13:1957-1968. doi:10.2147/JPR.S247208.
8. Jacobs MLYE, van den Dungen-Roelofsen R, Heemskerk J, Scheltinga MRM, Roumen RMH. Ultrasound-guided abdominal wall infiltration versus freehand technique in anterior cutaneous nerve entrapment syndrome (ACNES): Randomized clinical trial. BJS Open. 2021;5(6).
9. Clarke S, Kanakarajan S. Abdominal cutaneous nerve entrapment syndrome. Contin Educ Anaesth Crit Care Pain. 2015;15(2):60-63. doi:10.1093/bjaceaccp/mku016.
10. Van Assen T, Brouns JAGM, Scheltinga MR, Roumen RM. Incidence of abdominal pain due to the anterior cutaneous nerve entrapment syndrome in an emergency department. Scand J Trauma Resusc Emerg Med. 2015;23:19. doi:10.1186/s13049-015-0096-0.
11. Tanizaki R, Takemura Y. Anterior cutaneous nerve entrapment syndrome with pain present only during Carnett’s sign testing: A case report. BMC Res Notes. 2017;10:281. doi:10.1186/s13104-017-2816-1.
12. Smelt H, Pouwels S, Apers JA, Said M, Smulders J. Anterior cutaneous nerve entrapment syndrome: Two case reports of the forgotten diagnosis after bariatric surgery. Cureus. 2020;12(6). doi:10.7759/cureus.8499.
13. Sanchez Galindo B. Chronic abdominal pain due to entrapment of the anterior abdominal cutaneous nerve (ACNES): About a case. J Family Med Prim Care. 2022;11(8):4834-4836. doi:10.4103/jfmpc.jfmpc_228_22.
14. Okamoto T, Fukuda K. Anterior cutaneous nerve entrapment syndrome occurring after endoscopy. Case Rep Gastroenterol. 2020;14(2):377-382. doi:10.1159/000508440.
15. Kedia SK, Sidiq M, Gonnade NM, Banu SB, Prakash CHSJ, Yadav M. Interventional rehabilitation approach in anterior cutaneous nerve entrapment syndrome post nephrectomy: A case report. J Pharm Negat Results. 2023;14(Special Issue 1):697-699. doi:10.47750/pnr.2023.14.S01.95.