Nerve Pathology in Children with Anterior Cutaneous Nerve Entrapment Syndrome

Anterior cutaneous nerve entrapment syndrome (ACNES) is an underdiagnosed, but common, cause of abdominal pain in children. It is unknown if the involved nerves are normal or are pathologic and should be divided or released and retained. We present the pathology findings of resected nerves in children with ACNES.

Operative reports, pathology reports, and clinical notes of consecutive patients who underwent anterior neurectomy from December 2011 to September 2023 were reviewed.

One hundred and three pathology specimens from 78 patients were evaluated. Twenty-nine of the 103 specimens were from re-operative cases. Of the 103 pathology specimens, 71 (69%) had pathologic findings in the form of: myxomatous change (49, 69%), myelin vacuolar degeneration (22, 31%), perineural fibrosis (15, 21%), traumatic neuroma-like changes (2, 3%), and possible axonal injury (1, 1%). Four specimens (4%) did not have an identifiable nerve.

The majority of nerve specimens from patients with ACNES were found to have changes consistent with chronic nerve damage distal to the location of presumed entrapment. Resection of these cutaneous nerves, rather than release and retention, seems prudent.

III.