Ultrasound-Guided Ethanol Neurolysis for Anterior Cutaneous Nerve Entrapment  Syndrome in Children: A Retrospective Pilot Study

Purpose: Anterior cutaneous nerve entrapment syndrome (ACNES) is an underrecognized cause of chronic abdominal wall pain, resulting from entrapment of the thoracic anterior cutaneous branches (T7–T12) as they traverse the rectus abdominis fascia. In children and adolescents, ACNES can significantly impair quality of life, limiting participation in school and sports, and is often misdiagnosed.



Standard therapeutic strategies include local anesthetic infiltration, corticosteroid injections, pulsed radiofrequency ablation, and surgical neurectomy. For refractory cases, pulsed radiofrequency and surgical neurectomy have shown high success rates, with pediatric series reporting 86–100% effectiveness. Chemical neurolysis has also been described historically, primarily using phenol, with encouraging long-term results in adult cohorts. However, modern data are lacking, and no studies have specifically evaluated ethanol neurolysis, particularly in children. Our retrospective pilot study evaluates the feasibility and clinical outcomes of ultrasound-guided ethanol neurolysis in pediatric ACNES.

Materials and Methods: We retrospectively reviewed patients ≤18 years with ACNES who underwent ultrasound-guided ethanol injection between January 2015 and May 2025. Demographics, symptom duration, procedural details, pain scores, complications, and functional outcomes were extracted from the electronic medical record and PACS. The primary outcome was ≥50% pain reduction at first follow-up (2–6 weeks). Secondary outcomes were complications and functional improvement. During the preparation of this work, the authors used ChatGPT (GPT-5, OpenAI) to improve grammar, spelling, and readability.

Results: Of 15 patients diagnosed with ACNES between 2015 and 2025, 11 met inclusion criteria. All reported lifestyle limitations due to pain. Seven (63%) underwent a single ultrasound-guided ethanol injection and four (36%) required two sessions. Median baseline pain was 8/10 (range 5–10). After treatment, 8 (73%) achieved complete resolution, 2 (18%) had marked improvement, and 1 (9%) developed recurrent pain from another cause. No major complications occurred.

Conclusion: Ethanol neurolysis is a feasible and well-tolerated intervention for pediatric ACNES, providing meaningful pain and functional improvement in the majority of treated patients with minimal morbidity. These findings support ethanol neurolysis as a minimally invasive alternative to surgical neurectomy and warrant prospective evaluation in larger cohorts.