Chronic Abdominal Syndrome Due to Nervous Compression. Study of 100 Cases and Proposed Diagnostic-Therapeutic Algorithm

Abstract

ObjectiveIn the medical literature, thoracic disc protrusion has traditionally been considered a rare occurrence. We hypothesise that the incidence of such protrusions and their abdominal symptoms is higher than is generally believed and that their presence may account for a significant proportion of chronic non-visceral abdominal pains. Accordingly, the present study was designed to identify and quantify the symptoms experienced by patients with thoracic disc protrusion and to assess the relative risk of these symptoms being presented, compared to the general population.DesignWe conducted a cross-sectional study with a control group. The following comparison groups were analysed: case group, consisting of 100 patients diagnosed with thoracic disc protrusion in our hospital between February 2007 and October 2012, and control group consisting of 100 subjects from the general population, chosen at random. To compare the symptoms observed in each group, the following tests were applied to all study subjects: clinical examination, gastrointestinal-related quality of life (GIQLI) questionnaire and DN4 questionnaire. We also reviewed the subjects’ medical records for the previous 3 years.ResultsThe subjects in the case group had a significantly higher incidence of digestive-urologic symptoms, a poorer gastrointestinal quality of life and greater need of medical care than those in the control group. The differences were statistically significant for all the parameters studied. Almost all the case group subjects suffered chronic abdominal pain and/or digestive-urologic symptoms. We term this group of symptoms “chronic abdominal syndrome due to nervous compression”. Nevertheless, in most cases, no neurologic aetiology was suspected, and therefore the treatment given was ineffective. In view of the results obtained, we propose a diagnostic-therapeutic algorithm for such patients.ConclusionThoracic disc protrusion, as well as having a non-negligible incidence, is often associated with a digestive-urologic clinical syndrome, and this factor should be taken into account in all cases of chronic abdominal pain and other digestive-urologic symptoms when standard tests are negative, so that appropriate treatment may be given.

Anatomical Descriptive Study of 337 Thoracic Disc Herniations

“…This higher rate than in the study by Wood et al may be due to our inclusion of medium-sized and small hernias. As reported previously, [10,11,15] smaller hernias are also capable of generating important symptoms.…”

“…[14] High-resolution magnetic resonance (HRMN) imaging has increased the frequency of radiological diagnosis of HDT. In a previous study, [15] we reported that the frequency of this pathology is quite significant, and when we interviewed the patients affected, practically all of them were found to be symptomatic.…”

Thinking Outside the Box

“…2 The diagnostic yield of nerve conduction studies and electromyography has not been evaluated, but they might play a role in certain dubious cases, supporting a relationship between radiologic findings and symptoms, because thoracic disc protrusions occur in >11% of adults. 3 Important clues in this case were the radiation to the back, which appears in >90% of subjects with abdominal wall pain owing to thoracic disc protrusion, and the worsening induced by spinal movements, present in >50%. 3 Initial management includes conventional analgesia, calcium a 2-d ligands and tricyclic antidepressants.…”

“…3 Important clues in this case were the radiation to the back, which appears in >90% of subjects with abdominal wall pain owing to thoracic disc protrusion, and the worsening induced by spinal movements, present in >50%. 3 Initial management includes conventional analgesia, calcium a 2-d ligands and tricyclic antidepressants. Infiltration of the metamere wall, topical 5% lidocaine patches and opioid agonists might be used in more severe cases.…”

“…Infiltration of the metamere wall, topical 5% lidocaine patches and opioid agonists might be used in more severe cases. 3…”