Korean J Pain.  2013 Jul;26(3):291-294. 10.3344/kjp.2013.26.3.291.

Successful Treatment of Abdominal Cutaneous Entrapment Syndrome Using Ultrasound Guided Injection

• Hong MJ
• Kim YD
• Seo DH

• KMID: 2074031
• DOI: http://doi.org/10.3344/kjp.2013.26.3.291

Abstract

There are various origins for chronic abdominal pain. About 10-30% of patients with chronic abdominal pain have abdominal wall pain. Unfortunately, abdominal wall pain is not thought to be the first origin of chronic abdominal pain; therefore, patients usually undergo extensive examinations, including diagnostic laparoscopic surgery. Entrapment of abdominal cutaneous nerves at the muscular foramen of the rectus abdominis is a rare cause of abdominal wall pain. If abdominal wall pain is considered in earlier stage of chronic abdominal pain, unnecessary invasive procedures are not required and patients will reach symptom free condition as soon as the diagnosis is made. Here, we report a case of successful treatment of a patient with abdominal cutaneous nerve entrapment syndrome by ultrasound guided injection therapy.

Keyword

abdominal pain; abdominal wall; nerve compression syndromes; ultrasonography

MeSH Terms

Abdominal Pain
Abdominal Wall
Humans
Laparoscopy
Nerve Compression Syndromes
Rectus Abdominis

Figure

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  Fig. 1 Placement of ultrasound transducer and needle over the lateral end of the rectus abdominis muscle.

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  Fig. 2 Ultrasound guided block of the abdominal cuateneous nerve, using the transverse scan of rectus abdominis muscle. Under the ultrasound guidance (12-5 Hz linear probe), the needle was advanced with the short axis in plane technique to reach the target area. 1: Rectus abdominis, 2: Linea semilunaris, 3: Internal oblique, 4: Transversus abdominis, *: Abdominal cutaneous nerve, White arrows are marked tracing needle trajectory.

Reference

1. Lindsetmo RO, Stulberg J. Chronic abdominal wall pain--a diagnostic challenge for the surgeon. Am J Surg. 2009; 198:129–134. PMID: 19555786.

2. Srinivasan R, Greenbaum DS. Chronic abdominal wall pain: a frequently overlooked problem. Practical approach to diagnosis and management. Am J Gastroenterol. 2002; 97:824–830. PMID: 12003414.

3. Kanakarajan S, High K, Nagaraja R. Chronic abdominal wall pain and ultrasound-guided abdominal cutaneous nerve infiltration: a case series. Pain Med. 2011; 12:382–386. PMID: 21332928.

4. Kómár J, Varga B. Syndrome of the rectus abdominis muscle: a peripheral neurological condition causing abdominal diagnostic problems. J Neurol. 1975; 210:121–125. PMID: 51916.

5. Rhee HD, Park EY, Lee B, Kim WO, Yoon DM, Yoon KB. Treatment experiences of abdominal cutaneous nerve entrapment syndrome: a report of 3 cases. Korean J Pain. 2006; 19:292–295.

6. Abdominal wall tenderness test: could Carnett cut costs? Lancet. 1991; 337:1134. PMID: 1674021.

7. Applegate WV. Abdominal cutaneous nerve entrapment syndrome. Surgery. 1972; 71:118–124. PMID: 4332389.

8. Hall PN, Lee AP. Rectus nerve entrapment causing abdominal pain. Br J Surg. 1988; 75:917. PMID: 2972335.

9. Sippo WC, Gomez AC. Nerve-entrapment syndromes from lower abdominal surgery. J Fam Pract. 1987; 25:585–587. PMID: 3681220.

10. Sippo WC, Burghardt A, Gomez AC. Nerve entrapment after Pfannenstiel incision. Am J Obstet Gynecol. 1987; 157:420–421. PMID: 2956885.

11. Sharf M, Shvartzman P, Farkash E, Horvitz J. Thoracic lateral cutaneous nerve entrapment syndrome without previous lower abdominal surgery. J Fam Pract. 1990; 30:211–212. 214PMID: 2299315.

12. Spence EK, Rosato EF. The slipping rib syndrome. Arch Surg. 1983; 118:1330–1332. PMID: 6639342.

13. Greenbaum DS, Greenbaum RB, Joseph JG, Natale JE. Chronic abdominal wall pain. Diagnostic validity and costs. Dig Dis Sci. 1994; 39:1935–1941. PMID: 8082500.

14. Peleg R, Gohar J, Koretz M, Peleg A. Abdominal wall pain in pregnant women caused by thoracic lateral cutaneous nerve entrapment. Eur J Obstet Gynecol Reprod Biol. 1997; 74:169–171. PMID: 9306112.