Anterior Cutaneous Neurectomy - Child's Play?

Chronic abdominal pain (CAP) is a common entity in the pediatric population and has an extensive differential diagnosis. Anterior cutaneous nerve entrapment syndrome (ACNES) is an etiology that is not often diagnosed and requires an individualized approach. Treatment options for ACNES include nonsurgical and surgical, often a graded approach is used. A 12-year-old boy presented with CAP and was extensively evaluated as well as underwent multiple abdominal surgeries. He was eventually diagnosed with ACNES and underwent a trial conservative management. Although he initially showed improvement, his pain returned. He later underwent a neurectomy procedure with significant postoperative relief. The patient experienced significant relief post procedure. He experienced up to 70% relief in pain in the immediate postoperative period and at the end of 3 months, pain was completely absent. The patient was able to return to all his activities including active sports. The diagnosis and management of ACNES is a challenging condition, but this report seeks to highlight its importance as an unusual cause. Literature on the management of this condition is scarce, making it difficult to make informed decisions. Surgical neurectomy is seen as a favored procedure for children with moderate-good pain relief, especially for those who do not respond satisfactorily to local blocks.