Diabetic neuropathy, the great masquerader: truncal neuropathy manifesting as abdominal pseudohernia

To describe a patient with diabetic truncal neuropathy and suggest a helpful diagnostic approach to this entity.

We present a case report, with a focus on physical, computed tomographic, and electromyographic findings.

Because of an extensive differential diagnosis, diabetic truncal neuropathy is a rarely recognized and often misdiagnosed condition in patients with diabetes mellitus. In a 55-year-old man with a 13-year history of diabetes but no retinopathy, vasculopathy, or nephropathy, pain and a visible bulge in the left lower abdominal quadrant prompted radiographic assessment of the abdomen. A computed tomographic scan of the abdomen disclosed no mass but a weakening of the abdominal musculature suggestive of a pseudohernia. Subsequent electromyography showed evidence of polyradicular neuropathy. The patient was given treatment for pain control, and the pseudohernia resolved within 1 year.

In patients with diabetes who have a painful abdominal mass, the potential presence of a diabetic truncal neuropathy should be considered.