Abstract:
Background: Chronic abdominal pain is one of the most common reasons for gastroenterology referral, imaging, endoscopy, and repeat clinic visits. However, not all abdominal pain originates from intra-abdominal pathology. Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) is an underdiagnosed cause of chronic abdominal wall pain that is frequently mistaken for functional GI disorders, IBS, musculoskeletal pain, or even drug-seeking behavior. Delayed recognition results in unnecessary procedures, increased healthcare costs, and patient frustration. GI nurses play a pivotal role in identifying clinical clues that distinguish abdominal wall pain from visceral pathology.
Purpose of Presentation: This session will equip GI nurses with practical tools to recognize ACNES in outpatient clinics, infusion centers, and pre-/post-endoscopy settings.
Methods / Educational Approach:Using case-based learning from real-world gastroenterology practice, I will review:
•Relevant abdominal wall anatomy
•Pathophysiology of anterior cutaneous nerve entrapment
•Classic history features (localized pain, ability to point with one finger, worsening with movement)
•The clinical importance of Carnett’s sign
•Differentiation from visceral abdominal pain
•Diagnostic trigger point identification
•Role of local anesthetic injection as both diagnostic and therapeutic intervention
Interactive discussion will focus on how nurses can identify red flags, document key findings, and communicate effectively with providers.
Clinical Relevance for GI Nurses: Nurses are often the first to hear: “All my tests are normal, but I still hurt.” Recognizing ACNES allows nurses to advocate for appropriate evaluation, prevent unnecessary repeat procedures, and validate patient symptoms. Understanding this condition enhances triage accuracy, improves patient education, and reduces stigma surrounding chronic abdominal pain.
Results / Expected Outcomes:
Participants will gain confidence in identifying abdominal wall pain patterns, understand when to suspect ACNES, and learn how early recognition can significantly improve patient outcomes.
Conclusion: Awareness of ACNES transforms the approach to chronic abdominal pain. Empowering GI nurses with this knowledge improves diagnostic accuracy, reduces healthcare utilization, and most importantly, restores trust for patients who have long felt unheard.
Biography:
Dr. Sanjay Bhat is a board-certified gastroenterologist with over 30 years of clinical experience in private practice and hospital-based care. After retiring from solo practice in 2024, he continues to serve as a locum tenens gastroenterologist, supporting community hospitals and clinics. Dr. Bhat has a strong interest in practical, bedside diagnostic skills and improving interdisciplinary collaboration in GI care. He is passionate about educating nurses and physicians on underrecognized conditions such as abdominal wall pain syndromes to enhance patient outcomes and reduce unnecessary procedures.
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