gestodene and Abdominal-Pain

The etiology of chronic abdominal pain can be elusive. The diagnostic workup, therefore, often includes superfluous and expensive tests, as well as invasive procedures which do not contribute to the final diagnosis. Studies have shown that some patients suffer from prolonged pain in the abdominal wall and often are misdiagnosed and treated as having a visceral source for their complaints. The abdominal wall might be considered to be an unlikely source of prolonged abdominal pain, but one study reported that in 15% of patients with prolonged, nonspecific abdominal pain, the abdominal wall was the source of the complaint. Abdominal pain resulting from cutaneous nerve entrapment has not been reported previously in children and adolescents, nor has nerve entrapment been reported as a complication of oral contraceptives. The case of a 15-year-old girl who came to the hospital emergency room with abdominal pain of 3 months duration is reported. A comprehensive workup had not established a specific cause for the pain. On the basis of the clinical findings, the possibility of a cutaneous nerve entrapment was suggested. After the involved cutaneous nerve was selectively blocked by subcutaneous infiltration, the pain disappeared immediately and completely. Recognition of this apparently unusual condition can lead to gratifying results. It is proposed that oral contraceptive therapy may have caused changes in the abdominal wall which led to nerve entrapment and the ensuing severe, prolonged pain.. Women with prolonged pain in the abdominal wall are often subjected to expensive tests and invasive procedures that do little to clarify the pain's etiology. Cutaneous nerve entrapment syndrome is an easily curable yet frequently overlooked cause of such pain. This article reports the first case of abdominal wall pain caused by cutaneous nerve entrapment in an adolescent and as a complication of oral contraceptive (OC) use. The 15-year-old girl presented to an Israeli medical center with right lower abdominal pain of 3 months' duration. She had commenced use of a combined OC a few days before the onset of pain. Prior to this hospital visit, the adolescent had made three visits to the emergency room for intense abdominal pain, had been examined by 12 specialists, and underwent a battery of tests--all of which produced normal results. When cutaneous nerve entrapment was finally considered as a possible diagnosis, the patient was treated by local infiltration and block of the cutaneous nerves in the abdominal wall--a regimen that produced immediate, complete pain relief. It is speculated that the estrogen or progesterone in the OC caused a redistribution or retention of fluids in the abdominal wall, eventually causing pressure on a cutaneous abdominal nerve in the area of a scar from a previous appendectomy. The teen was able to continue OC use.

Topics: Abdominal Muscles; Abdominal Pain; Adolescent; Chronic Disease; Contraceptives, Oral, Synthetic; Female; Humans; Nerve Block; Nerve Compression Syndromes; Norpregnenes; Peripheral Nerves; Skin