Peripheral neuropathic mimics of visceral abdominal pain: Can physical examination limit diagnostic testing?

The American Journal of Emergency Medicine
Kenneth Frumkin, Liam F Delahanty

Abstract

The emergency department evaluation of patients with abdominal pain is most appropriately directed at identifying acute inflammation, infection, obstruction, or surgical disease. Doing so commonly involves "routine" (and often extensive) diagnostic imaging and laboratory testing. Benign mimics of serious visceral abdominal pain that can be diagnosed by physical exam and confirmed with local anesthetic injections have been identified over the last century. These syndromes derive from painful irritation of the intercostal nerves by a mobile rib below, or from impingement of the cutaneous branches of those same intercostal nerves as they penetrate the abdominal wall. These peripheral neuropathic mimics of visceral abdominal pain continue to go unrecognized and underdiagnosed. Our purpose is to review the affirmative diagnosis of non-visceral abdominal pain by physical examination. The consequences of failure to identify these conditions are considerable. In the search for a diagnosis that is literally at the provider's fingertips, patients frequently undergo months to years of fruitless and often invasive diagnostic tests, not uncommonly including unsuccessful surgeries. With proper consideration of and appropriate testing for vis...Continue Reading

References

Jan 1, 1978·Annals of Internal Medicine·F M Vincent
Nov 1, 1989·Postgraduate Medicine·S Abbou, J Herman
Sep 20, 1980·Lancet·J T Wright
Aug 27, 1983·British Medical Journal·D G Machin, J M Shennan
Nov 1, 1983·Archives of Surgery·E K Spence, E F Rosato
Jun 1, 1994·Gut·D Sharpstone, D G Colin-Jones
Sep 1, 1994·Digestive Diseases and Sciences·D S GreenbaumJ E Natale
Jul 1, 1993·Gut·E M Scott, B B Scott
Mar 1, 1997·Journal of Pain and Symptom Management·K A CranfieldA P Baranowski
Jul 1, 1997·Journal of Pediatric Surgery·D P Mooney, N A Shorter
Aug 5, 2000·The American Journal of Gastroenterology·T J McGarrityS J McGarrity
Nov 7, 2001·Paediatric Anaesthesia·D A SaltzmanS Harp
Mar 9, 2002·Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine·Jean-Yves MeuwlyDomenico Lepori
Jan 13, 2004·The British Journal of Surgery·R E B Andersson
May 11, 2006·The World Journal of Biological Psychiatry : the Official Journal of the World Federation of Societies of Biological Psychiatry·Johannes Thome, Christian Egeler
Jan 24, 2007·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Judd E HollanderFrances S Shofer
Sep 14, 2007·BMC Family Practice·François VerdonBernard Favrat
Nov 1, 1933·Annals of Surgery·J B Carnett, W Bates
Nov 8, 2008·BJU International·Stephen R KeoghaneDerek Pounder
Jun 27, 2009·American Journal of Surgery·Rolv-Ole Lindsetmo, Jonah Stulberg
Jun 12, 2010·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Terrence W BrownFrederick Levy
Mar 18, 1922·British Medical Journal·R Davies-Colley
Apr 19, 2011·Journal of Pediatric Surgery·Marc R ScheltingaRudi M Roumen
Oct 23, 2012·Journal of Pediatric Surgery·Roxana FuShawn D St Peter
Dec 18, 2012·Clinical Pediatrics·Nelson L Turcios
Jan 19, 2013·The Clinical Journal of Pain·Caterina PiraliDomenico De Grandis
May 16, 2013·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Chris L MooreAnnette Molinaro
Aug 29, 2013·Indian Journal of Anaesthesia·Rajender KumarMeenaxi Bose
Nov 8, 2013·European Journal of Pediatrics·Samira AkhnikhPeter de Winter
Nov 12, 2013·Primary Care·Amba AylooSrimannarayana Marella
Mar 4, 2014·Lancet·Marcello MiglioreEugenio Aguglia
Apr 25, 2014·BMC Research Notes·Trygve Nissen, Rolf Wynn
May 3, 2014·Physical Medicine and Rehabilitation Clinics of North America·Mitchell FreedmanJeffrey Henstenburg
Jan 2, 2015·BMJ Quality & Safety·Wendy LevinsonUNKNOWN Choosing Wisely International Working Group
Jan 7, 2015·Journal of Pain & Palliative Care Pharmacotherapy·Anudeep SaxenaAbhyuday Kumar
Jan 8, 2015·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Ling LiJohanna I Westbrook
Apr 19, 2015·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Tijmen van AssenRudi M Roumen
Jul 15, 2015·The Journal of Emergency Medicine·Carlos J Roldan, Na Hu
Aug 1, 2015·BMJ : British Medical Journal·Stephen Bruehl
Sep 4, 2015·Journal of Pediatric Gastroenterology and Nutrition·Murid SiawashMarc R Scheltinga
Sep 12, 2015·Journal of Pediatric Gastroenterology and Nutrition·Warren P Bishop
Nov 4, 2015·A & a Case Reports·Juan Javier Bolaños-VergarayMaria Bové Alvarez
Mar 8, 2016·American Journal of Surgery·Jelmer E OorEric J Hazebroek

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