Disclosures: James J. Bresnahan, MD: No financial relationships or conflicts of interest

Case Description: A 68-year-old woman presented to clinic with 3 months of right sided abdominal pain with radiation around the right flank. The pain started shortly after insertion of a continuous glucose monitor and formation of a subcutaneous hematoma. Her abdominal pain persisted despite removal of the device. She underwent computed tomography of the abdomen and pelvis, liver function tests, CCK, and hepatobiliary scintigraphy all of which were negative. She was diagnosed with functional abdominal pain and had no improvement with ibuprofen, acetaminophen, and pregabalin.

Setting: Outpatient musculoskeletal ultrasound clinic

Patient: 68-year-old woman with abdominal pain Assessment/

Results: The patient pointed to her right lower abdomen between the rectus abdominis and oblique muscles as the area of maximal pain and ultrasonography revealed exquisite sonographic palpatory pain localized to the right linea semilunaris where there was a mildly enlarged anterior cutaneous nerve consistent with entrapment syndrome (ACNES). She had a positive Pinch and Carnett sign. She subsequently underwent an ultrasound guided nerve block using 6mg betamethasone, 1ml 1% lidocaine, and 1ml 0.2% ropivacaine without any subcutaneous anesthetic. Pain subsequently improved from 8 to 0 on the NRS within 5 minutes and Pinch and Carnett signs were negative.

Discussion: The most common cause of abdominal wall pain is ACNES. Infiltration of the perineural area with lidocaine is highly sensitive and specific to the diagnosis. The use of steroid may decrease scarring and inflammation in the fibrous semilunar canal prolonging pain relief with a 70-93% response rate and ultrasound should be used to confirm appropriate needle placement. In the event of refractory pain, botulinum toxins, neurolytic agents, and radiofrequency ablation have been used.

Conclusion: The typical patient with ACNES has had abdominal wall pain for 25 months prior to diagnosis with an annual direct health care cost of more than $1,100. This approach offers a more effective and cost-efficient treatment.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/anterior-cutaneous-nerve-entrapment-syndrome-after-continuous-glucose-monitor-insertion-a-case-report/