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 (Carnett'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.