Chronic, refractory abdominal pain without a metabolic or structural gastroenterological etiology can be challenging for diagnosis and management. Even though it is rare, it has been reported that such a recurrent abdominal pain associated with radicular pattern can be derived from structural neurologic lesion like spinal cord tumor. We experienced an unusual case of chronic recurrent abdominal pain that lasted for two years without definite neurologic deficits in a patient, who has been harboring thoracic spinal cord tumor. During an extensive gastroenterological workup for the abdominal pain, the spinal cord tumor had been found and was resected through surgery. Since then, the inexplicable pain sustained over a long period of time eventually resolved. This case highlights the importance of taking into consideration the possibility of spinal cord tumor in differential diagnosis when a patient complains of chronic and recurrent abdominal pain without other medical abnormalities.

Citations

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• Spinal cord tumor presenting with neck stiffness
  Anood Alassaf, Rana Al Shami, Jehan Al Rayahi, William Mifsud, Khalid Al-Kharazi, Abdulqadir J. Nashwan
  Journal of Pediatric Surgery Case Reports.2021; 75: 102071.     CrossRef

Electrophysiologic monitoring during surgery for the spinal cord tumor is necessary for identification of the nerve root, prevention of the nerve injury, and prediction of postoperative prognosis. In other countries, intraoperative electrophysiologic monitorings are commonly done in various cases such as selective posterior rhizotomy, scoliosis, sponlylolisthesis, lipomeningocele, and spinal cord tumor, but it is not a common procedure in Korea except for the selective posterior rhizotomy.

We report 3 cases of electrophysiologic monitoring during sugery for the spinal cord tumor at lower thoracic level. Using multichannel EMG machine, we recorded free-run EMG, somatosensory evoked potential(SSEP) of tibial nerve, and compound motor unit action potential (CMAP) of various regions such as abdomen, lower extremity, and anus, stimulating nerve roots at the lower thoracic level.

We identified CMAP from rectus abdominis muscles only in the first case, but in the second case, we identified CMAP from tibialis anterior and gastrocnemius muscles which avoided the injury to lumbosacral roots. In the third case, SSEP improved immediately after we removed the mass at lower thoracic level.

We concluded that intraoperative electrophysiologic monitoring combined with recording CMAP is a useful procedure to minimize neural tissue damage during surgery for the spinal cord tumor at lower thoracic level.