Chronic Abdominal Wall Pain: a Missed Diagnosis

Chronic abdominal wall pain (CAWP) refers to the pain originating from the abdominal wall which is often misdiagnosed as arising from a source inside the abdominal cavity, often resulting in inappropriate diagnostic investigations, unsatisfactory treatment, and considerable costs. In spite of being implicated in as many as 10% of patients with chronic abdominal pain of unknown cause seen by gastroenterologists, this condition has received little research and clinical attention (1). Thompson et al estimated that about 1% of all referrals for chronic abdominal pain made to a general surgeon were eventually considered to be CAWP (2). In a study of patient referrals to gastroenterologists over a 5-year period, Costanza et al showed that CAWP comprised 7.8% (133 of 1708) patients referred with abdominal pain. Referring physicians were able to suspect CAWP in only 3% of their patients, which suggests the relative unawareness of this condition (3). By contrast, physicians aware of this condition have reported seeing between one to two such patients in a week to three per day (4). Even in 1926, when Carnett first described the examination process to differentiate pain of abdominal wall origin from intra abdominal pain, he commented on CAWP being a frequently missed diagnosis (5).