Chronic abdominal pain caused by thoracic disc herniation.
A patient with 7 yr of severe disabling chronic epigastric abdominal pain attributed to chronic pancreatitis was seen in consultation before a 95% pancreatectomy for pain control. Previous attempts to identify and treat the pain lead to extensive radiographic, pharmacological, endoscopic, and surgical interventions, including a Roux-en-Y pancreaticojejunostomy. Pain control was poor despite implantation of a continuous intrathecal morphine infusion pump. A focused physical examination, however, raised the suspicion of thoracic disc disease, which was confirmed after myelogram with computed tomography. Disruption of the T7-T8 disc with protrusion into the vertebral canal and displacement of the spinal cord with an associated bone spur were identified. A microsurgical thoracic discectomy was performed. Immediately, the pain began resolving, and she was pain free and off her medications within several weeks. To our knowledge, this is the first description of a herniated thoracic disc presenting as the pain of chronic pancreatitis. The diagnosis of thoracic disc syndrome requires a high index of suspicion and should be considered in patients with chronic abdominal pain.
Whitcomb
D C
DC
Department of Medicine, University of Pittsburgh, Pennsylvania, USA.
Martin
S P
SP
Schoen
R E
RE
Jho
H D
HD
D015746:Abdominal Pain / Q000209:etiology*; D000328:Adult; D002908:Chronic Disease; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000175:diagnosis; D010195:Pancreatitis / Q000150:complications / Q000175:diagnosis; D013904:Thoracic Vertebrae