Diabetic truncal neuropathy presenting as abdominal hernia

Two patients with longstanding type II diabetes mellitus presented with focal, unilateral protrusion of the abdominal wall, thought to be due to abdominal hernia. They were evaluated extensively for intra-abdominal pathology but none was found. In one patient, the protrusion was associated with spontaneous burning pain and hyperpathia, but in the other it was painless. In the patient seen during the acute phase there was denervation in paraspinal and abdominal muscles on EMG examination. In both patients, the protrusion subsided without specific treatment in 2 to 4 months. This seldom-described manifestation of diabetic truncal neuropathy masquerading as abdominal hernia needs a higher profile to avoid misdiagnosis and unnecessary investigation. Diagnosis may be quickly established by EMG examination of the paraspinal and abdominal muscles.