Background

Chronic abdominal pain is commonly attributed to gastrointestinal, genitourinary, or gynecologic disorders. However, spinal pathology may produce referred visceral pain through complex neuroanatomical and autonomic pathways. Because this phenomenon is uncommon, abdominal pain of spinal origin is frequently misdiagnosed.

The Case

A 70-year-old Asian woman presented with a 20-year history of persistent right lower quadrant abdominal pain. Symptoms were worsened by prolonged standing and walking and partially relieved when supine. She occasionally experienced radiation to the right thigh.

Repeated gastrointestinal evaluations, including abdominal computed tomography and colonoscopy, failed to identify a cause. Multidisciplinary assessment eventually prompted lumbar imaging, which demonstrated degenerative changes and a right L4–L5 disc herniation with stenosis of the right lateral recess.

Physical examination revealed positive straight-leg-raising and mild right lower-extremity weakness. These findings raised suspicion for lumbar radiculopathy presenting as referred abdominal pain.

Diagnostic Reasoning

A CT-guided selective right L4 nerve root block produced approximately 80% pain relief within 30 minutes, strongly supporting a spinal origin. The dramatic response to the diagnostic block established the relationship between nerve root compression and the patient's longstanding abdominal symptoms.

This case illustrates an important principle: unexplained abdominal pain, particularly when influenced by posture or accompanied by back pain or radicular symptoms, should prompt consideration of spinal disease.

Treatment

Two days after confirmation of the diagnosis, the patient underwent unilateral biportal endoscopic lumbar discectomy. Intraoperatively, a migrated L4–L5 disc herniation causing significant compression of the right L4 nerve root was identified and removed.

Postoperatively, abdominal pain improved markedly, with reduction of the visual analog score to 2. At 12 months, the patient remained symptom-free without analgesics and had resumed normal activities.

Why This Case Matters

Lumbar disc disease is classically associated with low back pain and sciatica, yet atypical presentations can mimic visceral disorders. Referred abdominal pain likely results from viscerosomatic convergence and autonomic pathways linking lumbar nerve roots with abdominal sensory networks.

This report underscores several important lessons:

• Chronic abdominal pain may occasionally originate from the spine.
• Mechanical symptoms and associated radicular complaints are important diagnostic clues.
• Diagnostic nerve root blocks can help establish the source of pain.
• Minimally invasive decompression surgery may provide durable relief when conservative approaches fail.
• Multidisciplinary collaboration can prevent prolonged diagnostic delays.

Clinical Take-Home Message

Not all abdominal pain originates within the abdomen. In patients with unexplained, treatment-resistant abdominal pain—particularly when symptoms vary with posture or coexist with back pain or sciatica—lumbar radiculopathy should be considered. Recognition of this uncommon presentation can spare patients years of unnecessary investigations and lead to effective treatment.

Reference

He C, Liu Y, Bao R, Zhang H, Chen H. Diagnosis and treatment of abdominal pain of spinal origin: a case report. Journal of Medical Case Reports. 2026;20:290. https://doi.org/10.1186/s13256-026-06043-6.

Journal of Medical Case Reports is the world’s first international, PubMed-listed, medical journal devoted to publishing case reports from all medical disciplines and will consider any original case report that expands the field of general medical knowledge, and original research relating to case reports. The journal is open access, and strongly endorses the CARE guidelines for case reports, requiring authors to submit populated CARE checklists with submissions to improve transparency in reporting.