| 제목 |
Chronic Upper Abdominal Pain Diagnosed as Bilateral Diabetic Thoracic Polyradiculopathy |
| 소속 |
Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Department of Rehabilitation Medicine1, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Department of Rehabilitation Medicine2 |
| 저자 |
Hyeong Seop Kim1*, Eun Shin Lee1, Se-Woong Chun2, Seung-Kyu Lim2, Heesuk Shin2† |
Introduction
Diabetic thoracic polyradiculopathy is characterized by abrupt onset and predominantly unilateral radicular pain in diabetic patients. Unlike peripheral neuropathy which cause numbness in hand and foot, it cause mainly complaining of severe abdominal pain. So, it is difficult to discriminate from other diseases that cause abdominal pain. This leads to misdiagnosis and delayed diagnosis, and need several tests for differential diagnosis. We report a case of severe abdominal pain patient diagnosed diabetic thoracic polyradiculopathy by electrophysiologic study
Case presentation
In this case report, a 39-year-old male patient presented severe left upper abdominal pain from 4 months ago, the pain character was ‘burning sense’.
He was diagnosed as diabetes 7 years ago and has not treated, and he complained of numbness in the hand and foot, and was diagnosed with diabetic polyneuropathy 5 years ago.
When the abdominal pain first appeared, he visited local general hospital and performed Gastrofibroscopy and abdominal CT which was normal. But his abdominal pain gradually spread to the left flank and back, after then to right flank and back. So, he visited another hospital and cervical MRI was done which showed cervical HIVD with thecal sac compression. And he was recommended cervical operation. So he visited our hospital neurosurgery department. Before surgery the neurosurgen rechecked cervical MRI(Fig 1) & thoracic MRI(Fig 2) and requested eletrophysiologic study to our department.
The electrophysiologic study result are as Table 1 ; Nerve conduction study (NCS) showed distal sensory and motor polyneuropathy pattern in both upper and lower extremities. And denervation potentials were recorded at both thoracic paraspinal musculature from T10 to L2 level. Thoracic dermatomal SEP showed delayed latency. So we reported that the patient might have most probabley diabetic polyradiculopathy and diabetic thoracic polyradiculopathy.
The patient was transferred to our department for conservative treatment and we prescribed gabapentin, imipramine, tramadol and TENS was applied at the painful area. After 1wk his pain was much improved and discharged to home.
Conclusion
Diabetic thoracic polyradiculopathy should be suspected in diabetics with severe pain in multiple thoracic root distribution. Proper early diagnosis is essential, because the pain associated with diabetic thoracic polyradiculopathy is well respond to conservative treatment. And unnecessary invasive treatment(cervaical operation in this case) should be avoided. |
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Fig 1. Demonstration Cervical MRI
Fig 2. Demonstration Thoracic MRI
Table 1. Demonstration Electrophysiologic study
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