Medical evacuation for unrecognized abdominal wall pain: a case series

Chronic abdominal pain is a frequently encountered complaint in the primary care setting. The abdominal wall is the etiology of this pain in 10 to 30% of all cases of chronic abdominal pain. Abdominal cutaneous nerve entrapment at the lateral border of the rectus abdominis muscle has been attributed as a cause of this pain. In the military health care system, patients with unexplained abdominal pain are often transferred to military treatment facilities via the Military Medical Evacuation (MEDEVAC) system.

We present two cases of patients who transferred via MEDEVAC to our facility for evaluation and treatment of chronic abdominal pain. Both patients had previously undergone extensive laboratory evaluation, imaging, and invasive procedures, such as esophagogastroduodenoscopy before transfer. Upon arrival, history and physical examinations suggested an abdominal wall source to their pain, and both patients experienced alleviation of their abdominal wall pain with lidocaine and corticosteroid injection.

This case series highlights the need for military physicians to be aware of abdominal wall pain. Early diagnosis of abdominal cutaneous nerve entrapment syndrome by eliciting Carnett's sign will limit symptom chronicity, avoid unnecessary testing, and even prevent medical evacuation.