[An uncommon cause of recurrent abdominal pain in a 63-year-old obese woman].
METHODS
A 63-year-old woman was admitted because of abdominal pain for 12 months, associated with an increasing abdominal distension. One month before a gastroscopy had revealed mild gastritis. The taking of proton pump inhibitors did not improve her symptoms. There was no relevant neurological or psychiatric past history.


METHODS
Ultrasound and laboratory tests demonstrated a fatty liver and increased serum levels of lipoproteins. Magnetic resonance imaging revealed an increase in subcutaneous and intraperitoneal adipose tissue. Endoscopy did not show any additional significant findings.


METHODS
The patient had adiposis dolorosa. Initially she was given daily a combination of mexiletine 400 mg and 75 mg Amitriptyline. After a few days the ailment decreased and had disappeared completely after one week. Three months later the dosage was reduced to 100 mg mexiletine and 25 mg Amitriptyline daily. After another two months all medication was discontinued. At follow-up after 12 months the symptoms had not recurred.


CONCLUSIONS
This case demonstrates that abdominal pain is not always caused by diseases of the visceral hollow organs. It must also be borne in mind that abdominal pain may be associated with adipose tissue, as is the case in adiposis dolorosa. The disease can be successfully treated, as in this case, using a combination of mexiletine and Amitriptyline.
Medizinische Klinik II, Krankenhaus Bad Oeynhausen.
J
J
Tiesmeier
H
H
Warnecke
F
F
Schuppert
D015746:Abdominal Pain / Q000188:drug therapy / Q000209:etiology*; D000274:Adiposis Dolorosa / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D000639:Amitriptyline / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008801:Mexiletine / Q000627:therapeutic use*; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000188:drug therapy; D012008:Recurrence; D016896:Treatment Outcome
D018712:Analgesics, Non-Narcotic; D000639:Amitriptyline; D008801:Mexiletine