To the Editor.—
Recognition of pain secondary to abdominal wall pathologic conditions may prevent unnecessary laparotomies.
Report of a Case.—
In February 1978, a 33-year-old woman came to our Pain Control Center with a one-year history of lower left abdominal pain during the midpoint of her menstrual cycle. Over the course of a year, this patient consulted frequently with her gynecologist, who could not relieve her pain with conservative drug or hormonal therapy. After a normal laparotomy in October 1977, the patient was referred to us for evaluation before a planned hysterectomy. While attempting to differentiate between pain of visceral or somatic origin, we noted the pain and tenderness to palpation over the left abdomen was intensified as the abdominal muscles were contracted via leg lift in the supine position. This sign in a patient with chronic pain is strongly suggestive of a nerve entrapment syndrome involving the rectus abdominis
Tung AS, Tenicela R, Giovannitti J. Rectus Abdominis Nerve Entrapment Syndrome. JAMA. 1978;240(8):738–739. doi:10.1001/jama.1978.03290080028013