Multidisciplinary Management for Anterior Cutaneous Nerve Entrapment Syndrome (ACNES): A Case Series Including a Long COVID-19 Patient

Anterior cutaneous nerve entrapment syndrome (ACNES) is an underrecognized cause of chronic abdominal wall pain. While nerve block injections are typically used as conservative treatment, persistent or recurrent cases may require surgical neurectomy. This case series presents five patients, including a long COVID-19 case, who underwent surgical treatment for ACNES at our institution. We integrated clinical presentation, CT imaging, surgical findings, rehabilitation strategies, and histopathological analysis to explore a multidisciplinary treatment approach. Preoperative CT was helpful in detecting muscle atrophy or nerve visualization, which guided rehabilitation and surgical planning. Histopathology revealed chronic compressive neuropathy in all cases, even among those with mild symptoms, suggesting that pain severity alone should not dictate surgical indications. Rehabilitation was effective in reducing muscle contraction and localizing symptoms, contributing to postoperative success and recurrence prevention. Our findings support the importance of individualized, proactive management that combines imaging, surgery, and rehabilitation, and highlight the potential for COVID-19-related neuropathy to contribute to ACNES.