Spinal Cord Tumors That Present as Chronic Abdominal Pain: Analysis of the Literature

Background: Chronic abdominal pain without a structural or metabolic gastroenterological etiology can be extremely challenging to diagnose and treat. Patients presenting with an associated radicular pattern of pain may alert the clinician to a possible structural neurologic cause of the symptoms. Methods: We present the case of a 70 year old woman who presented to our institution with an 18 month history of right upper quadrant abdominal pain. She had no associated symptoms or provoking factors. She underwent an extensive gastroenterology evaluation, including colonoscopy that was unrevealing. Ultrasound demonstrated gallstones and she was evaluated for cholecystectomy. She subsequently developed right costal margin pain. Her symptoms remained stable over the course of the next year. Follow-up general surgical evaluation was still unconvincing that the gallstones were the etiology of her symptoms. A thoracic spinal MR demonstrated a large intradural extramedullary mass at T8. Patient’s neurologic exam was normal. Results: She underwent a thoracic laminectomy and resection of a meningioma using intraoperative electrophysiological monitoring. Her abdominal pain resolved. Conclusions: Patients can present with months to years of elusive abdominal symptoms only to be eventually found to be harboring an undiagnosed spinal tumor. We discuss the case and review the literature reports of spinal tumors masquerading as chronic abdominal pain.