BACKGROUND: Chronic abdominal pain often presents as a diagnostic challenge due to a broad differential. Abdominal wall pain is often overlooked and mistaken for visceral pain. Extensive diagnostic workups, such as laboratory tests, imaging, and endoscopic procedures, are frequently performed and yield inconclusive results.

CASE REPORT: A 29-year-old woman presented with chronic lower abdominal pain following a cesarean section. Diagnostic workup, including imaging and consultations, was unrevealing. On examination, the pain was localized over the prior incision site with a positive Carnett’s sign. Point-of-care ultrasound revealed a hypoechoic lesion in the abdominal wall. Ultrasound-guided aspiration yielded purulent fluid, and cultures grew Streptococcus parasanguinis. The patient experienced symptom relief following aspiration and underwent surgical excision.

CONCLUSIONS: Abdominal wall abscesses are a rare but treatable cause of chronic abdominal pain. Carnett’s sign and point-of-care ultrasound are valuable tools for early diagnosis, which can prevent unnecessary testing, facilitate targeted treatment, and improve outcomes

KEYWORDS: Abdominal wall abscess, Carnett’s sign, case report, chronic pain, streptococcus parasanguinis