Treatment strategies for anterior cutaneous nerve entrapment syndrome in children: A systematic review
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In brief
In brief
This systematic review of 224 pediatric ACNES patients demonstrates that a step-up treatment approach is most effective: starting with trigger point injections (38-87% success) and reserving anterior neurectomy for refractory cases (86-100% success). The evidence supports conservative management first, with surgery as a reliable second-line option for this frequently missed cause of chronic abdominal pain in children.
Written by the GCMD Library team from the article.
Abstract
Background
Anterior cutaneous nerve entrapment syndrome (ACNES) is a frequently overlooked cause of chronic abdominal pain in children. Currently, both nonsurgical and surgical treatment options are available to treat this disease. The objective was to give insight into the success rate of different treatment strategies for children with ACNES, and provide treatment recommendations for physicians based on the published evidence.
Method
A literature search of PubMed, Embase.com and the Wiley/Cochrane Library was conducted for studies published up to 25 February 2020. Randomized controlled trials, prospective or retrospective cohort studies, meta-analyses and literature reviews describing the outcome of different treatment strategies for children (<18 years old) with ACNES with a follow-up duration of at least four weeks were included.
Results
Six studies, involving 224 patients, were included with an overall quality reported to be between fair and poor. Treatment success of local injections with an anesthetic agent into the trigger point ranged from 38% to 87% with a follow-up ranging from 4 weeks to 39 months. In addition, treatment success of anterior neurectomy ranged from 86% to 100%, with a follow-up duration ranging from 4 weeks to 36 months.
Conclusion
A step-up treatment strategy should be applied when treating pediatric patients with ACNES. This strategy starts with an injection with a local anesthetic agent, reserving surgery (anterior neurectomy) as a viable option in case of persistent pain.
Level of evidence
II.