Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2019 Jan;94(1):139-144. doi: 10.1016/j.mayocp.2018.09.018.
Chronic abdominal wall pain is a common, yet often overlooked, cause of chronic abdominal pain in both the outpatient and inpatient settings. This disorder most commonly affects middle-aged adults and is more prevalent in women than in men. In chronic abdominal wall pain, the pain occurs due to entrapment of the cutaneous branches of the sensory nerves that supply the abdominal wall. Although the diagnosis of chronic abdominal wall pain can be made using patient history, physical examination, and response to a trigger point injection, patients often undergo extensive and exhaustive laboratory, imaging, and procedural work-up before being diagnosed with this condition, given it is often overlooked. Carnett's sign is a specialized physical examination technique that can help support the fact that the abdominal pain originates from the abdominal wall rather than from the abdominal viscera. The mainstay of treatment consists of reassurance, activity modification, over-the-counter analgesic agent, and trigger point injection. In rare cases, treatment with chemical neurolysis or surgical neurectomy may be required.
慢性腹壁疼痛是门诊和住院患者慢性腹痛的常见但常被忽视的原因。这种疾病最常影响中年成年人，女性比男性更为常见。在慢性腹壁疼痛中，疼痛是由于供应腹壁的感觉神经的皮支被嵌顿引起的。虽然可以通过病史、体格检查和触发点注射的反应来诊断慢性腹壁疼痛，但由于这种疾病经常被忽视，患者通常在被诊断为这种疾病之前会接受广泛而详尽的实验室、影像学和程序检查。卡内特征是一种专门的体格检查技术，可以帮助支持这样一个事实，即腹痛源自腹壁，而不是来自腹部内脏。治疗的主要方法包括安慰、活动调整、非处方镇痛药和触发点注射。在极少数情况下，可能需要化学神经溶解或手术神经切除术治疗。
