Diário da Espinha

Thoracic Disc Herniation Presenting with Predominant Abdominal Pain

Abstract

Hiroyasu Fujiwara, Takashi Kaito, Takahiro Makino and Kazuo Yonenobu

Introduction: The incidence of symptomatic thoracic disc herniation (TDH) is quite low, and most patients present with either radiculopathy as pain in the chest wall or thoracic myelopathy involving the lower extremities. However, not only these typical symptoms, but also various other symptoms pointing to other general diseases can be the sole presenting complaints. We describe a rare case in which a patient presented with predominant abdominal pain caused by thoracic disc herniation.

Materials andMethods: Retrospective data analysis and review of the literature.

Results: A 45-year-old man experienced sudden onset of abdominal pain and presented to our internal medicine outpatient clinic. Due to obvious concomitant paraplegia, he was referred to our department. Physical examination revealed spastic paraplegia below the T10 dermatome level. Thoracic magnetic resonance imaging showed disc herniation at the T9-10 level. Herniotomy was performed, and abdominal pain completely disappeared immediately postoperatively.

Conclusions: Although the anatomical location within a given axial cross-section of the spinal cord where visceral pain is processed is still controversial, some reports have defined the visceral nociceptive pathway as ascending in the midline of the dorsal columns, particularly in the nucleus gracilis. Damage to this pathway seems to represent a cause of abdominal pain with TDH. Further investigations in this area are required to elucidate the exact mechanisms involved. Surgeons should be aware of atypical presentations of TDH, to prevent misdiagnosis and progression to irreversible myelopathy.