Open AccessAbdominal Pain from a Thoracic Epidural Abscess
Author(s) -
Lim Erle ChuenHian,
Seet Raymond C.S.
Publication year - 2006
Publication title -
journal of general internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.746
H-Index - 180
eISSN - 1525-1497
pISSN - 0884-8734
DOI - 10.1111/j.1525-1497.2005.02102001_3.x
Subject(s) - medicine , paraplegia , epidural abscess , urinary retention , surgery , abscess , myelopathy , weakness , thoracic vertebrae , lumbar , spinal cord , anesthesia , radicular pain , constipation , lumbar vertebrae , psychiatry
Spinal epidural abscesses are difficult to diagnose and are associated with high morbidity and mortality. A 61‐year‐old Chinese woman fell and was admitted 5 days later with constant epigastric pain and constipation. Clinical examination was initially normal. Five days after admission, she developed urinary retention and mild lower limb weakness, progressing overnight to paraplegia. Clinical examination was consistent with a thoracic myelopathy. Neuroimaging showed a paracentral fluid collection compressing the thoracic cord at T8 level. Emergent neurosurgical intervention revealed an epidural abscess, which was drained. She responded to a 9‐week course of antibiotics and recovered fully. Radicular pain from thoracic pathology can mimic intraabdominal pathology, and a high index of suspicion and prompt surgical intervention are essential to avoid the potentially devastating consequences of delayed recognition of epidural abscesses.