title: Surgery for refractory anterior cutaneous nerve entrapment syndrome (ACNES) in children.
abstract: BACKGROUND
  Chronic abdominal pain (CAP) in children may be caused by entrapment of cutaneous branches of intercostal nerves (anterior cutaneous nerve entrapment syndrome, or ACNES). Local injection of anesthetics may offer relief, but pain is persistent in some children. This study is the first to describe the results of a 'cutaneous neurectomy' in children with refractory ACNES.
  
  
  METHODS
  Chronic abdominal pain children with suspected ACNES refractory to conservative treatment received a cutaneous neurectomy in a day care setting. They were interviewed postoperatively using an adapted quality of life questionnaire (testing quality of life in children).
  
  
  RESULTS
  All subjects (n = 6; median age, 15 years; range, 9-16 years) were previously healthy school-aged children without prior illness or earlier surgery. Each presented with intense abdominal pain and a positive Carnett sign. Blood, urine tests, and abdominal ultrasound investigations were normal. Delay in seeing a physician was 16 weeks, and school absence was 25 days. Before surgery, quality of life (pain, daily activities, and sports) was greatly diminished. After the neurectomy, all children were free of pain and had resumed their normal daily routine (follow-up at 6 months).
  
  
  CONCLUSIONS
  The role of the abdominal wall as the source of childhood CAP is underestimated. Some children with CAP have ACNES. Children with refractory ACNES should be offered a cutaneous neurectomy, as this simple technique is effective in the short and long term.
authors.affiliation: Department of Surgery, Máxima Medical Center, 5500 MB Veldhoven, The Netherlands. Electronic address: m.scheltinga@mmc.nl.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Scheltinga
authors.affiliation: Department of Surgery, Máxima Medical Center, 5500 MB Veldhoven, The Netherlands.
authors.forename: Oliver B
authors.initials: OB
authors.lastname: Boelens
authors.affiliation: Department of Pediatrics, Máxima Medical Center, 5500 MB Veldhoven, The Netherlands.
authors.forename: Walther E
authors.initials: WE
authors.lastname: Tjon A Ten
authors.affiliation: Department of Surgery, Máxima Medical Center, 5500 MB Veldhoven, The Netherlands.
authors.forename: Rudi M
authors.initials: RM
authors.lastname: Roumen
mesh_terms: D000009:Abdominal Muscles / Q000294:innervation*; D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D000293:Adolescent; D002648:Child; D002908:Chronic Disease; D006801:Humans; D009408:Nerve Compression Syndromes / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D010147:Pain Measurement; D010525:Peripheral Nerves / Q000601:surgery*; D011788:Quality of Life; D012867:Skin / Q000294:innervation*; D011795:Surveys and Questionnaires