Diagnosis and treatment of abdominal pain of spinal origin: a case report

BACKGROUND: Clinically, abdominal pain can also be caused by lesions of the vertebral bodies, intervertebral discs, and other structures. It is usually due to degenerative changes, injuries, or herniations of the intervertebral discs, as well as stimulation or compression of the sympathetic nerve plexus associated with the vertebral bodies, leading to nonspecific abdominal pain, medically referred to as "abdominal pain of spinal origin". CASE PRESENTATION: A 70-year-old Asian female presented with a 20-year history of unexplained right lower abdominal pain, initially managed as a gastrointestinal condition. Despite extensive evaluations (including CT and colonoscopy), the etiology remained elusive. Multidisciplinary collaboration eventually identified a right-sided L4-L5 disc herniation compressing the right L4 spinal nerve root. A diagnostic selective nerve root block of the right L4 root was performed, resulting in 80% pain relief within 30 minutes, confirming the spinal origin. Two days later, the patient underwent unilateral biportal endoscopic (UBE) discectomy. Postoperatively, the abdominal pain resolved significantly, and the Visual Analog Scale (VAS) score decreased to 2. At the 12-month follow-up, the patient remained pain-free. CONCLUSIONS: Lumbar radiculopathy can mimic visceral abdominal pain. In patients with intractable abdominal pain, spinal screening is crucial. Diagnostic nerve blocks serve as a key tool to confirm the diagnosis and guide minimally invasive surgical treatment.