Spinal-origin abdominal pain secondary to silent osteoporotic compression fractures: A case report

Abdominal pain in older individuals is frequently attributed to visceral disorders; however, vertebral compression fractures can present with isolated abdominal pain. Herein, we report a diagnostically challenging case that has not been previously published as a preprint. A woman in her early 80s presented with a 2-week history of persistent right upper quadrant dull pain, which had not been relieved by antispasmodic medications. Physical examination revealed mild tenderness in the right upper quadrant. Laboratory tests showed mild anemia (hemoglobin, 91 g/L) and severe osteoporosis. Results of contrast-enhanced computed tomography and endoscopy did not explain the cause of the pain. After failure of conservative treatment, magnetic resonance imaging revealed a new compression fracture of the T8 vertebra (considered as the source of pain corresponding to the right upper quadrant dermatome) and an incidentally discovered new fracture at L4. Percutaneous vertebroplasty was performed on the T8 and L4 vertebrae, and the pain was completely relieved within 24 h postoperatively. For older patients with unexplained abdominal pain, the possibility of asymptomatic osteoporotic compression fractures should be considered. Early spinal magnetic resonance imaging can help avoid diagnostic delay.