CHRONIC ABDOMINAL-PAIN CAUSED BY THORACIC DISC HERNIATION

A patient with 7 yr of severe disabling chronic epigastric abdominal p ain attributed to chronic pancreatitis was seen in consultation before a 95% pancreatectomy for pain control, Previous attempts to identify and treat the pain lead to extensive radiographic, pharmacological, en doscopic, and surgical interventions, including a Roux-en-Y pancreatic ojejunostomy. Pain control was poor despite implantation of a continuo us intrathecal morphine infusion pump. A focused physical examination, however, raised the suspicion of thoracic disc disease, which was con firmed after myelogram with computed tomography, Disruption of the T7- T8 disc with protrusion into the vertebral canal and displacement of t he spinal cord with an associated bone spur were identified, A microsu rgical thoracic discectomy was performed. Immediately, the pain began resolving, and she was pain free and off her medications within severa l weeks, To our knowledge, this is the first description of a herniate d thoracic disc presenting as the pain of chronic pancreatitis, The di agnosis of thoracic disc syndrome requires a high index of suspicion a nd should be considered in patients with chronic abdominal pain.