Chronic abdominal wall pain-A diagnostic challenge for the surgeon

BACKGROUND: Chronic abdominal wall pain (CAWP) occurs in about 30% of all patients presenting with chronic abdominal pain. METHODS: The authors review the literature identified in a PubMed search regarding the abdominal wall as the origin of chronic abdominal pain. RESULTS: CAWP is frequently misinterpreted as visceral or functional abdominal pain. Misdiagnosis often leads to a variety of investigational procedures and even abdominal operations with negative results. With a simple clinical test (Camett's test), >90% of patients with CAWP can be recognized, without risk for missing intra-abdominal pathology. CONCLUSION: The condition can be confirmed when the injection of local anesthetics in the trigger point(s) relieves the pain. A fasciotomy in the anterior abdominal rectus muscle sheath through the nerve foramina of the affected branch of one of the anterior intercostal nerves heals the pain. (C) 2009 Published by Elsevier Inc.