Incidental Epiploic Appendagitis With Contralateral Anterior Cutaneous Nerve Entrapment Syndrome in an Adolescent

Abdominal pain in adolescents often prompts imaging that may reveal incidental findings unrelated to the presenting symptoms, and anchoring on such findings can delay recognition of the true diagnosis. A 17-year-old girl with no significant past medical or surgical history presented to the emergency department with acute right lower quadrant pain of approximately 12 hours' duration. The pain was sharp, nonradiating, exacerbated by movement, and unrelated to meals. Contrast-enhanced computed tomography performed to evaluate for appendicitis revealed left lower quadrant epiploic appendagitis, anatomically discordant with her symptoms. The anatomic mismatch prompted a focused abdominal wall examination, which demonstrated a discrete right-sided trigger point with positive Carnett sign and altered cutaneous sensation, findings most consistent with anterior cutaneous nerve entrapment syndrome. Ultrasound-guided rectus sheath nerve block provided partial relief, and the patient was managed conservatively without surgery. Over subsequent months of multidisciplinary follow-up, her intermittent pain has been controlled with supportive care, with no new hospital admissions and no gynecologic pathology identified. This case highlights anterior cutaneous nerve entrapment syndrome as an underrecognized cause of focal abdominal pain in adolescents and illustrates the importance of anatomic correlation between imaging findings and clinical symptoms.