Department of Community Medicine, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan.
Department of Emergency and Critical Medicine, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan.
Am J Case Rep. 2022 Nov 2;23:e937740. doi: 10.12659/AJCR.937740.
BACKGROUND It is important to identify the cause of chronic abdominal pain, especially in older adults. Thoracolumbar vertebral compression fractures are one potential cause, and can be difficult to identify. We report a case of an older man with severe unexplained abdominal pain and nausea due to an inadequately treated thoracolumbar vertebral compression fracture. CASE REPORT A 93-year-old man fell 89 days prior to visiting the hospital and was diagnosed with a compression fracture in the Th12 vertebra. He started wearing a corset on the day of the injury. Two days later, he developed abdominal pain, mild nausea, and a decreased appetite. He attributed the symptoms to wearing the corset; therefore, he stopped wearing it. The cause of his abdominal symptoms could not be determined by blood tests and computed tomography of the abdomen. A 45° upper body elevation induced marked right lower abdominal pain (consistent with the dominant region of Th12-L1), and decreased temperature sensation was observed in the same region. We concluded that the abdominal pain was caused by neuropathy owing to a ruptured Th12 vertebral fracture. The patient was treated conservatively, the abdominal pain and nausea resolved 7 weeks after admission, and the patient was discharged. CONCLUSIONS When assessing patients with unexplained abdominal pain, vertebral compression fractures should be included in the differential diagnosis and the necessary diagnostic assessments should be made as early as possible. Early diagnosis provides a wider range of treatment options and can contribute to minimizing functional decline.
识别慢性腹痛的病因很重要，尤其是在老年人中。胸腰椎压缩性骨折是潜在的原因之一，且可能难以识别。我们报告了一例因未充分治疗的胸腰椎压缩性骨折而导致严重不明原因腹痛和恶心的老年男性病例。
一名 93 岁男性在就诊前 89 天摔倒，被诊断为 T12 椎体压缩性骨折。受伤当天他开始佩戴胸腰支具。两天后，他出现腹痛、轻度恶心和食欲不振。他将这些症状归因于佩戴胸腰支具，因此停用了支具。腹部血液检查和 CT 检查未能确定他的腹部症状的原因。45°上身抬高引起明显的右下腹痛（与 T12-L1 的优势区域一致），同一区域的温度感觉下降。我们得出结论，腹痛是由 T12 椎体骨折引起的神经病变所致。患者接受了保守治疗，入院后 7 周腹痛和恶心缓解，患者出院。
在评估不明原因腹痛的患者时，应将椎体压缩性骨折纳入鉴别诊断，并尽早进行必要的诊断评估。早期诊断为患者提供了更广泛的治疗选择，并有助于最大限度地减少功能下降。
