[Abdominal intercostal neuralgia: a forgotten cause of abdominal pain]

Abstract

Four patients, 3 women aged 39, 36 and 58 and a man aged 51, had been experiencing recurring bouts of abdominal pain for periods varying from a few months to years. The pain could be provoked by palpation of a small circumscript area in the lower abdomen. A positive Carnett's sign (pain intensification during palpation while contracting the abdominal muscles by raising the head, whilst lying flat) may aid the diagnosis. An injection ofa local anaesthetic agent confirmed the diagnosis of nerve entrapment and appeared therapeutic in one patient. The other three patients experienced long-term relief following surgical nerve excision. Establishing a diagnosis in patients with abdominal cutaneous nerve entrapment syndrome is often delayed due to physicians being unaware of this condition. Most patients have to undergo numerous investigations including laparoscopies and explorative laparotomies, often to no avail. This syndrome should be considered in patients with chronic abdominal pain syndromes.