Anterior cutaneous nerve entrapment syndrome (ACNES) disguised as recurrent abdominal pain: a diagnostic challenge with a simple solution

Anterior cutaneous nerve entrapment syndrome (ACNES) is an under-recognised cause of chronic abdominal or chest wall pain in the era of increased reliance on diagnostic imaging and laboratory studies. We present the case of a man in his mid-60s who was hospitalised eight times over a 2-year period for unexplained abdominal pain despite extensive non-diagnostic workups. Careful re-examination, focusing on physical examination, demonstrated a positive Carnett's sign, leading to the diagnosis of ACNES. Ultrasound-guided trigger point injection with corticosteroid and local anaesthetic led to immediate symptom relief, confirming the diagnosis. This case highlights the diagnostic value of the physical exam and the need to consider ACNES in patients with persistent abdominal pain and normal imaging and laboratory studies, as early diagnosis can reduce symptom burden, prevent unnecessary testing and improve patient outcomes.