Chronic abdominal wall pain--a diagnostic challenge for the surgeon.
BACKGROUND
Chronic abdominal wall pain (CAWP) occurs in about 30% of all patients presenting with chronic abdominal pain.


METHODS
The authors review the literature identified in a PubMed search regarding the abdominal wall as the origin of chronic abdominal pain.


RESULTS
CAWP is frequently misinterpreted as visceral or functional abdominal pain. Misdiagnosis often leads to a variety of investigational procedures and even abdominal operations with negative results. With a simple clinical test (Carnett's test), >90% of patients with CAWP can be recognized, without risk for missing intra-abdominal pathology.


CONCLUSIONS
The condition can be confirmed when the injection of local anesthetics in the trigger point(s) relieves the pain. A fasciotomy in the anterior abdominal rectus muscle sheath through the nerve foramina of the affected branch of one of the anterior intercostal nerves heals the pain.
Lindsetmo
Rolv-Ole
RO
Department of Gastrointestinal Surgery, University Hospital of North Norway, Tromsø, Norway. rolv.ole.lindsetmo@unn.no
Stulberg
Jonah
J
D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D034861:Abdominal Wall / Q000294:innervation*; D002908:Chronic Disease; D003937:Diagnosis, Differential; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D009408:Nerve Compression Syndromes / Q000150:complications / Q000175:diagnosis / Q000628:therapy