Berhanu Melaku Tsediew, Kebede Molla Asnake, Tessfaw Adamu Tigabu, Tekle Alemayehu Beharu, Birhanu Anteneh Messele, Deresa Meron Teka
Emergency Department, school of medicine, College of Medicine and Health science, Mizan Tepi university, Mizan Aman, Ethiopia.
Department of Medicine, College of Medicine and health science, Mizan Tepi University, Mizan Aman, Ethiopia.
Int J Emerg Med. 2024 Sep 27;17(1):124. doi: 10.1186/s12245-024-00720-3.
Abdominal cutaneous nerve entrapment syndrome (ACNES) is characterized by severe, mostly refractory, chronic pain due to the entrapment of the cutaneous branches of the lower torso intercostal nerves at the lateral edge of the rectus abdominis muscle. ACNES is rare compared to other pregnancy-related peripheral neuropathies and is often overlooked as a differential diagnosis for abdominal pain, despite the diagnosis relying primarily on patient history and physical examination. Emergency physicians and other medical personnel's lack of exposure to such cases results in unnecessary laboratory requests, repeated visits, and increased fear and tension for the patient.
A 26-year-old primigravida on her second trimester of pregnancy presented to our Emergency department with persistent localized right upper quadrant abdominal pain. Despite repeated visit to the nearby hospital, no diagnosis was settled and the pain persisted. At our ED after a thorough history, physical examination and diagnostic test no abnormality was found. Finally Abdominal cutaneous nerve entrapment syndrome (ACNES) was considered and a mixture of 1 ml 2% lidocaine with adrenaline and 1 ml dexamethasone (4 mg) was infiltrated into the fascial plane in a fanning fashion into the most tender area using a modified technique and the patient reported significant improvement in pain.
Abdominal cutaneous nerve entrapment syndrome (ACNES) is a cause of abdominal pain in pregnancy that is often overlooked. The objective of this study is to describe a rare case of ACNES in a 26-year-old primigravida woman who presented to a low-resource emergency department to assist patient management.
腹部皮神经卡压综合征（ACNES）的特征是下胸部肋间神经的皮支在腹直肌外侧缘受压，导致严重的、大多难以治愈的慢性疼痛。与其他妊娠相关的周围神经病变相比，ACNES较为罕见，尽管其诊断主要依赖患者病史和体格检查，但它常被忽视作为腹痛的鉴别诊断。急诊医生和其他医务人员缺乏对这类病例的接触，导致不必要的实验室检查申请、反复就诊，增加了患者的恐惧和紧张情绪。
一名26岁初产妇，处于妊娠中期，因持续性右上腹局部疼痛就诊于我院急诊科。尽管多次前往附近医院就诊，但仍未明确诊断，疼痛持续存在。在我院急诊科，经过详细的病史询问、体格检查和诊断性检查，未发现异常。最终考虑为腹部皮神经卡压综合征（ACNES），采用改良技术，将1毫升含肾上腺素的2%利多卡因和1毫升地塞米松（4毫克）混合液呈扇形注入最压痛区域的筋膜平面，患者报告疼痛明显改善。
腹部皮神经卡压综合征（ACNES）是妊娠期腹痛的一个常被忽视的原因。本研究的目的是描述一例罕见的ACNES病例，该病例为一名26岁初产妇，就诊于资源有限的急诊科，以协助患者管理。
