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A Vertebral Complication Associated with Pancreatitis in a Fifty-Year-Old Woman1
A fifty-year-old woman was admitted to the hospital with epigastric and left upper-quadrant pain, loss of appetite, nausea and vomiting, and vague low-back pain that radiated to the left thigh. The back pain became worse the following day. Seven weeks earlier, the patient had been admitted for pancreatitis and had been diagnosed with a pancreas divisum, which occurs when the embryologic ventral and dorsal pancreatic anlagen fail to fuse. The patient had no history of alcohol abuse, back pain, or rheumatologic disease, and she had not taken any medication.
Palpation of the spine at the thoracolumbar junction resulted in intense pain. Deep tendon reflexes and sensation were normal. The serum amylase level was marginally elevated. The patient's condition improved after marsupialization of a pancreatic pseudocyst was performed, although the lumbar pain persisted. A radiograph of the spine revealed mild spondylosis. When the patient was discharged a few weeks later, she still had low-back pain of varied intensity.
She was admitted again one week later with abdominal pain, low-back pain that radiated to the left thigh, and dysesthesia in the proximal-lateral portion of the left thigh. Clinical examination revealed a positive Lasègue sign at 50° on the left side. Flexion of the left hip joint was weaker than that of the right. The weakness was classified as grade 4 (of 5) and was attributed to the presence of pain in the hip. The leg was not diffusely weak, however, and at subsequent examinations, the strength in the left hip appeared to be normal. Percussion of the spinous processes at the thoracolumbar junction did not elicit pain. The deep-tendon reflexes were normal. Clinical and neurological examinations did not reveal impingement of the lateral femoral cutaneous nerve. Blood cultures were negative. A bone scan (Fig. 1) and magnetic resonance images (Figs. 2-A and 2-B) were acquired.
Fig. 1 |
Fig. 1 Technetium-99m-methylene diphosphonate bone scan.
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Fig. 2-A |
Fig. 2-B |
Figs. 2-A and 2-B Sagittal magnetic resonance images of the thoracolumbar spine, acquired with use of a 0.5-T superconducting magnet. Fig. 2-A T2-weighted spin-echo image. Fig. 2-B Nonenhanced T1-weighted spin-echo image.
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