Bone Tumors, Abdominal Pain, and Aspirin

Physicians report an unusual case of a man with abdominal pain that responded to aspirin therapy, in the October issue of Gastroenterology. It turns out that the pain was caused by a prostaglandin-producing benign bone tumor.

Harpal S. Dhaliwal et al. describe examination of a 33-year-old man with an 18-month history of moderate-to-severe abdominal pain, which was worse at night, in the left abdomen below umbilicus—the pain was continuous dull or intermittently sharp.

The site of pain was tender (without rebound tenderness or discrete tender points), and the patient immediately grabbed the examining hand to stop further palpation. The tenderness did not disappear when he raised his legs, and worsened with twisting movements of the trunk. His chest and cardiovascular and nervous systems were normal.

A diagnosis was made based on findings from contrast-enhanced computed tomography.

Magnetic resonance imaging of the spine confirmed a relatively well-defined lesion in the left posteroinferior aspect of the T11 vertebra

Magnetic resonance imaging of the spine confirmed a relatively well-defined lesion in the left posteroinferior aspect of the T11 vertebra

The patient’s chronic abdominal wall pain was found to be caused by inflammatory left T11 radiculopathy, mediated by prostaglandins released from a spinal osteoid osteoma. He was given aspirin (325 mg twice/day), which greatly relieved his pain for 9 months, and then he was given increasing doses for another 5 months.

At this point, the authors decided to resect the lesion. The patient reported immediate relief of pain just after the surgery and remained well after 6 months of follow up.

The authors explain that chronic abdominal wall pain can have diverse etiologies (nerve entrapment syndromes, truncal neuropathies, abdominal wall hernias or hematomas, slipping rib syndrome, or spinal pathologies). The unilateral distribution of pain that did not cross the midline raised the authors’ suspicion of a spinal pathology, reinforced by worsening of pain with twisting of the spine.

Osteoid osteoma is a benign bone tumor characterized by nocturnal pain and pain relief with aspirin. The pain is produced by the large amounts of prostaglandins released from the tumor (aspirin blocks the prostaglandin synthesis by inhibiting cyclooxygenase).

Dhaliwal et al. explain that the abdominal pain observed in this patient probably resulted from prostaglandin-mediated inflammation of the T11 spinal nerve.

Dhaliwal et al. say this case is unusual in that many gastroenterologists hesitate to give aspirin to patients with abdominal pain because of its gastrointestinal side effects.

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