II. Causes: Hernia

  1. Abdominal Wall Hernia
    1. Umbilical Hernia
    2. Incisional Hernia
    3. Epigastric Hernia or Hypogastric hernia
    4. Spigelian Hernia (rare)
      1. Transversus aponeurosis defect at lateral rectus abdominis inferior to arcuate line
  2. Groin Hernia
    1. Inguinal Hernia
    2. Femoral Hernia

III. Causes: Neuropathy

  1. Herpes Zoster
    1. Postherpetic Neuralgia
  2. Mononeuritis multiplex
    1. Vasculitis
    2. Diabetes Mellitus (Diabetic Thoracic Polyradiculopathy)
      1. Severe nerve root T6 to T12 truncal pain
      2. Longstreth (2005) Best Pract Res Clin Gastroenterol 19(2): 275-81 [PubMed]
  3. Nerve root compression or impingement
    1. Thoracic Spine Radiculopathy
      1. Spinal level T7 to L1 Nerve Roots
    2. Ilioinguinal nerve root entrapment (or Iliohypogastric nerve entrapment)
      1. Common lower Abdominal Pain cause (esp. with prior Hernia Repair, appendectomy)
    3. Rectus abdominis nerve root entrapment
      1. Lateral cutaneous branches of intercostal nerves
      2. Anterior cutaneous branch of subcostal nerve
      3. Anterior cutaneous branches of intercostal nerves (anterior cutaneous nerve entrapment)
        1. Entrapment at the lateral rectus border onset in the upper Abdomen
        2. Localized unilateral sharp pain
        3. Most common cause of Abdominal Wall Pain
    4. Nerve root entrapment after Inguinal Hernia repair
      1. Lateral cutaneous branches of subcostal nerve
      2. Lateral cutaneous branch of iliohypogastric nerve

IV. Causes: Musculoskeletal Injury and Trauma

  1. Abdominal Trauma or athletic injury
    1. Myofascial injury
    2. Abdominal wall Muscle Strain
    3. Rectus abdominis rupture
    4. Abdominal wall hematoma (post-laparoscopy or Abdominal Trauma)
    5. Idiopathic intraabdominal adhesions
    6. Sports Hernia (Groin Pain)
  2. Surgical scar related changes
    1. Neuroma formation
    2. Recurrent Endometriosis
  3. Slipping Rib Syndrome (Ribs 8 to 10)
    1. Sharp, stabbing upper Abdominal Pain
    2. Diagnose by eliciting pain with hooking maneuver

V. Causes: Specific to Women

  1. Abdominal Wall Endometriosis
  2. Desmoid tumor
    1. Dysplastic tumor often in young women

VI. Causes: Miscellaneous

  1. Spider Bite
  2. Xiphodynia
    1. Reproducible pain on palpation of the xiphoid process
  3. Adiposis dolorosa (Dercum Disease, Anders Disease)
    1. Multiple painful abdominal wall Lipomas (obese patients)
  4. Infection
    1. Trichinosis
    2. Abdominal wall abscess

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