Chronic Abdominal Wall Pain (ACNES)

Added 04 Jul, 2017 [ssba]

Presenting complaint

The patient had been suffering from abdominal pain for nearly 8 months. The pain was localised to a discrete area in the lower abdomen. The pain was exacerbated by sitting down for too long, bending and excessive physical activity. The patient was largely housebound over the last several months because of the intensity of her pain.


The patient had seen various specialists in the past including Gastrointestinal physician, Lower GI surgeon, Gynaecologists and the Pain team. She had been admitted to the hospital with intense pain on multiple occasions but was discharged without any specific diagnosis. She was investigated with various blood tests, CT scan of the abdomen, MRI scan of the bowel, MRI scan of the pelvis but no cause was found for her pain.

She was prescribed strong opioids which caused sickness and constipation. She could not tolerate drugs like Amitriptyline and Pregabalin.


The patient saw Dr. Krishna at his private clinic in Bristol, desperate for some answers. Dr. Krishna diagnosed abdominal cutaneous nerve entrapment syndrome (ACNES), based on history and examination findings.

Dr. Krishna performed an ultrasound guided injection targeting the abdominal cutaneous nerve at the site of her pain. The patient was pain-free within a few minutes of the injection.


The patient continues to be pain-free several days after the abdominal cutaneous nerve block. The patient will be considered for pulsed radiofrequency ablation of the abdominal cutaneous nerve if the pain comes back in the near future.

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