A Diagnostic Limitation of Carnett's Maneuver: A Case of Deep-Seated Abdominal Wall Angiolipoma Mimicking Visceral Pain.

Chronic abdominal wall pain is often overlooked, leading to unnecessary investigations for visceral etiologies. Carnett's sign is widely used to distinguish abdominal wall pain from visceral pain, but its limitations must be recognized. A 29-year-old man presented with a six-year history of recurrent, throbbing right lower abdominal pain triggered by coughing or positional changes. Despite localized tenderness near McBurney's point, Carnett's sign was negative, and no mass was palpable. Imaging studies revealed a 16-cm lipomatous tumor located deep within the abdominal wall, between the external and internal oblique muscles. The tumor was surgically resected and histopathologically diagnosed as angiolipoma, resulting in complete resolution of symptoms. This case illustrates that a negative Carnett's sign does not definitively exclude abdominal wall pathology, particularly when lesions are deep-seated and escape mechanical stress during muscle contraction. Clinicians should consider abdominal wall disorders when clinical symptoms suggest such an etiology, regardless of Carnett's sign results.