Successful Ultrasound-Guided Management of Abdominal Anterior Cutaneous Nerve Entrapment Syndrome (ACNES): Case Report

Abdominal pain is a prevalent symptom with various possible causes, one of which is Anterior Cutaneous Nerve Entrapment Syndrome (ACNES), a frequently overlooked and underdiagnosed condition that can result in anterior abdominal pain. ACNES accounts for 10–30% of chronic abdominal wall pain cases, with nerve entrapment commonly occurring along the lateral border of the rectus muscle. However, entrapment can also occur at other locations, complicating diagnosis and management. In this report, we describe two cases that illustrate this variability: one patient experienced nerve entrapment at the medial border of the rectus muscle, while the other had entrapment at the lateral border. The differing entrapment locations highlight the challenges in diagnosing ACNES accurately, particularly without the aid of imaging techniques. Ultrasound played a crucial role in diagnosing and managing these cases, as it allowed for the precise localization of the entrapment site and enabled targeted intervention, which was critical for symptom relief in both patients. The successful use of ultrasound in these cases underscores its value as a non-invasive, effective tool for both diagnosis and management of ACNES. Ultrasound guidance can significantly improve diagnostic accuracy and guide appropriate therapeutic interventions, making it essential for clinicians managing chronic abdominal pain, especially when conventional tests yield inconclusive results. This report contributes to a growing body of evidence supporting the utility of ultrasound in diagnosing ACNES, an otherwise challenging condition, and offers a concise review of relevant literature to further aid in clinical understanding. Recognizing the role of ultrasound in diagnosing ACNES can improve patient outcomes and help avoid unnecessary treatments for those with chronic abdominal pain attributed to this often misunderstood syndrome.