Incidence of abdominal pain due to the anterior cutaneous nerve entrapment syndrome in an emergency department

Tijmen van Assen, Jill A G M Brouns, Marc R Scheltinga, Rudi M Roumen

Patients with chronic abdominal pain occasionally suffer from the anterior cutaneous nerve entrapment syndrome (ACNES). A substantial number of patients report previous visits to an emergency department (ED) with acute pain. Aim of this study was to obtain the incidence of ACNES in patients presenting with abdominal pain in the ED of a Dutch teaching hospital. In this observational study, data sets of all patients visiting Máxima Medical Center's (MMC) ED in 2011-2012 were searched for key terms 'ACNES', 'intercostal neuralgia' or 'abdominal wall pain'. Files of potential patients living within hospital's adherence area were checked using accepted criteria indicating the presence of ACNES. Disease incidence was calculated as a ratio to the hospital's adherence data. The ACNES MMC 2013's incidence in patients evaluated in the surgical outpatient department was also calculated. During the study period, 473 ED patient files met inclusion criteria. A total of 88 patients belonging to MMC's adherence area were diagnosed with ACNES leading to a mean 22/100.000 ACNES yearly incidence rate. About one of 50 patients with abdominal pain visiting the ED suffered from ACNES. A 35/100.000 outpatient department ACNES incidence rate was calculated in the year of 2013. Combining these two ratios, a 1:1800 ACNES incidence in the general population was obtained. In an ED setting of a Dutch teaching hospital, approximately 2% of patients presenting with acute abdominal pain suffered from ACNES. ED physicians should consider ACNES in abdominal pain patients with normal laboratory or imaging tests.