Adhesion-induced chronic abdominal pain: a case report on the diagnostic value of Carnett's test

Abstract

Background: Chronic abdominal pain is a common clinical problem. However, diagnosing chronic abdominal pain often requires detailed diagnostic evaluations in addition to sufficient history taking and physical examination, owing to its uncertain etiology.

Case presentation: We report a case of a 36-year-old man with chronic abdominal pain originating from postoperative adhesions. Postoperative adhesions are common phenomena, and abdominal surgery can cause severe abdominal pain, the source of which can be difficult to detect. Carnett's test is useful to detect abdominal wall tenderness and to determine the affected abdominal quadrant. Incorporating its use with a detailed chronological clinical history contributes to the improvement of diagnostic accuracy. In addition to the above-mentioned information, attention to subtle imaging findings may provide greater diagnostic accuracy.

Conclusions: Abdominal pain induced by postoperative adhesions was reduced by laparoscopic adhesiolysis. Carnett's test is an effective tool for evaluating pain and detecting its cause.

Keywords: Adhesion; Carnett’s test; Chronic abdominal pain.

Fig. 1

An Ishikawa diagram (fish bone diagram) for a man presenting with a complaint of “chronic abdominal pain”

Fig. 2

Carnett’s test A (a) and Carnett’s test B (b, c). First, the examiner confirms the area of tenderness with the patient in a relaxed, supine position (a). Second, the examiner confirms whether tenderness continues, worsens, or decreases at the same point while the patient raises the legs (b) or elevates the head and shoulders (c)

Fig. 3

The transverse abdominal muscle shows atrophy at the postoperative scar on plain abdominal coronal computed tomography (a) and plain abdominal transverse computed tomography (b). Arrows indicate adhesive region of the greater omentum

Fig. 4

Adhesion was observed between the peritoneum and greater omentum, liver, and ascending colon (a). Laparoscopic adhesiolysis was conducted at those adhesive regions (b)