GASTROENTEROLOGY ARTICLE OF THE WEEK
August 15, 2002
Srinivasan R, Greenbaum DS. Chronic abdominal wall pain: A frequently overlooked problem. Am J Gastroenterol 2002;97:824-830.
1. Abdominal wall pain may arise from
a. T7-T12 radicular lesions
b. thoracic viscera
c. S1-S3 radicular lesions
d. nerve entrapment by abdominal wall lesions
e. myofascial trigger points
2. Clinical characteristics of CAWP include
a. always described as sharp
b. once it appears, it is persistent. Spontaneous resolution is rare
c. radiation can be widespread, sometimes extending posteriorly over the
dermatome
d. multiple sites are rare
e. the patient is usually able to describe the painful area using the fingertip
3. Local therapy of abdominal wall pain
a. injection with bupivacaine and triamcinolone is often effective
b. use of phenol injection to ablate achieve neurolysis is useful if frequent recurrence after anesthetic injections
c. most patients need 1 to 3 sessions to have prolonged relief
d. incorrect diagnosis should be suspected if relief is <50%
e. local injection in the abdominal wall helps pain of radicular origin.
True or False
4. In patients with CAWP, allodynia is common, often triggered by light stroking.
5. Entrapment of the anterior cutaneous nerve appears to be the most common cause of CAWP
6. Local injection with anesthetics + steroids afford relief only for 1 to 2 weeks.
7. Tenderness on exam is most often elicited near surgical scars or at the lateral edge of the rectus muscle
8. Guarding is unusual and suggests intraabdominal pathology
9. Tenderness of a localized area of the abdominal wall during muscle tensing indicates the presence of abdominal wall pain and is known as Carnett’s sign