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Anterior Cutaneous Nerve Entrapment Syndrome in Children

A Prospective Observational Study

Kifer, Tomislav MD*; Mišak, Zrinjka MD, PhD*; Jadrešin, Oleg MD*; Hojsak, Iva MD, PhD*,†,‡

The Clinical Journal of Pain: July 2018 - Volume 34 - Issue 7 - p 670–673
doi: 10.1097/AJP.0000000000000573
Original Articles

Objective: Anterior cutaneous nerve entrapment syndrome (ACNES) is often an overlooked cause of abdominal pain. Data for pediatric patients, especially with regard to the treatment modalities are scarce. The aim of this study was to present a treatment modality of ACNES with combined local subfascial anesthetic and corticosteroid injection in a prospectively collected cohort of pediatric patients.

Methods: This was a prospective observational long-term study that included pediatric patients who were diagnosed with ACNES in a tertiary care pediatric center and who were followed-up for at least 12 months (median: 1.7 y; range: 1 to 2.7 y). All children were treated by ultrasound-guided subfascial injection of 40 mg 1% lidocaine and 4 mg dexamethasone into the rectus abdominis muscle in the place of the most severe pain (trigger point infiltration).

Results: The study included 38 children (28, 73.7% female; median age: 15 y). The majority of patients had pain in the lower right abdominal quadrant and were diagnosed in a median of 6 (range: 0.5 to 50) months after symptoms started. Overall, 24 (63%) patients achieved sustained symptom-free remission after a median of 1 (mean: 1.6; range: 1 to 5) trigger point infiltration during the first treatment session. Five (13%) children were surgically treated because of a lack of long-term response. Children who were surgically treated required a higher number of block applications during the first session of treatment, compared with children who were successfully treated conservatively.

Discussion: ACNES in children can be successfully treated by a combined local subfascial anesthetic and corticosteroid trigger point infiltration.

*Children’s Hospital Zagreb

University of Zagreb School of Medicine, Zagreb

University J.J. Strossmayer School of Medicine Osijek, Osijek, Croatia

The authors declare no conflict of interest.

Reprints: Iva Hojsak, MD, PhD, Referral Center for Pediatric Gastroenterology and Nutrition, Children’s Hospital Zagreb, Klaiceva 16, Zagreb 10000, Croatia (e-mail:

Received July 5, 2017

Received in revised form November 6, 2017

Accepted November 13, 2017

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