Diabetic neuropathy, the great masquerader: truncal neuropathy manifesting as abdominal pseudohernia.
OBJECTIVE
To describe a patient with diabetic truncal neuropathy and suggest a helpful diagnostic approach to this entity.


METHODS
We present a case report, with a focus on physical, computed tomographic, and electromyographic findings.


RESULTS
Because of an extensive differential diagnosis, diabetic truncal neuropathy is a rarely recognized and often misdiagnosed condition in patients with diabetes mellitus. In a 55-year-old man with a 13-year history of diabetes but no retinopathy, vasculopathy, or nephropathy, pain and a visible bulge in the left lower abdominal quadrant prompted radiographic assessment of the abdomen. A computed tomographic scan of the abdomen disclosed no mass but a weakening of the abdominal musculature suggestive of a pseudohernia. Subsequent electromyography showed evidence of polyradicular neuropathy. The patient was given treatment for pain control, and the pseudohernia resolved within 1 year.


CONCLUSIONS
In patients with diabetes who have a painful abdominal mass, the potential presence of a diabetic truncal neuropathy should be considered.
Chiu
Harvey K
HK
Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA.
Trence
Dace L
DL
D000082:Acetaminophen / Q000627:therapeutic use; D000588:Amines / Q000008:administration & dosage; D003509:Cyclohexanecarboxylic Acids / Q000008:administration & dosage; D003929:Diabetic Neuropathies / Q000175:diagnosis* / Q000188:drug therapy; D003937:Diagnosis, Differential; D004576:Electromyography; D000077206:Gabapentin; D046449:Hernia, Abdominal / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy; D011129:Polyradiculoneuropathy / Q000175:diagnosis* / Q000188:drug therapy; D014057:Tomography, X-Ray Computed; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage
D000588:Amines; D003509:Cyclohexanecarboxylic Acids; D000082:Acetaminophen; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin