Sports Medicine
Alec J. Birnbaum, BS
Medical Student
Rowan-Virtua SOM
Voorhees, New Jersey, United States
Emily Sears, DO
Resident Physician
NYU Rusk Rehabilitation
New York, New York, United States
Salvador Portugal, DO
Assistant Professor, Attending
NYU Rusk Rehabilitation
New York, New York, United States
Alec J. Birnbaum, BS
Rowan-Virtua SOM
Voorhees, New Jersey, United States
Abdominal wall pseudohernia secondary to thoracic radiculopathy
Case Description:
This is a 64-year-old male with a history of HIV, pre-diabetes, Hepatitis B who presented to the clinic with persistent, stabbing, abdominal pain with radiation to the right flank and lower abdomen for three months. The pain began after lifting weights in the gym. One month after injury, he underwent robotic surgery for suspected umbilical hernia. Physical examination revealed protrusion of the right lower abdomen with sensation intact and absent right abdominal reflex. Preoperatively, the patient had indicated the locations of pain; however, on laparoscopy no hernia was noted in this area. Adhesions were present between the abdominal wall and omentum and lysed. MRI thoracic spine was ordered and revealed T11-T12 disc bulge extended through the right neural foramina, indentation of the ventral thecal sac, and mild overall central canal narrowing. Abdominal ultrasound was ordered for further evaluation and the patient was instructed to follow up after completion of studies.
Discussions:
We present a patient with an unusual case of abdominal wall pseudohernia secondary to thoracic radiculopathy. Abdominal wall pseudohernia is a rare condition whereby the abdominal wall herniates without any disruption to the fascia in response to denervation of the abdominal muscles. Etiology is most commonly related to post-herpetic changes, diabetes, surgical injury, and lower thoracic or upper lumbar disc herniation. In the case of our patient, the etiology is most likely secondary to the disc bulge of T11-T12. Literature remains scarce with few descriptions of this condition; however, similar reports relate causes to T11-12 herniation, as seen in this patient, or other lower thoracic nerve roots.
Conclusions:
Thoracic radiculopathy may present with unusual presentations such as abdominal wall pseudohernia. For patients with unclear etiology, neuropathic pain, or dermatomal symptoms in the abdomen, thoracic radiculopathy should be considered.
