A Medical Case Masquerading as Surgical Pathology in an Individual Living with Diabetes

Abstract

Diagnosing the cause of abdominal pain in a young type 1 diabetic can be a challenging task and involves a wide array of differential diagnosis. Most commonly the pain is thought to be secondary to diabetic neuropathy. It becomes even more problematic if there is significant weight loss, if extensive investigations have not found any organic pathology and if the pain does not fit into any pattern of diabetic neuropathy. We present such a case where a young 21-years-old female diabetic had lost 16 kgs in 6 months due to diffuse left sided abdominal pain with radiation to the back. It was also associated with a very poor diabetic control with a HbA1C of 150 mmol/l. Despite trying a wide variety and combination of different pain killers (Amitriptyline, Paracetamol, Codeine, Duloxetine, Pregabalin, TENS machine, oral Morphine and Tramadol), there was no relief and the patient continued to lose weight. The investigations which included Short Synacthen test, contrast CT of the abdomen/pelvis, MRI of the abdomen, capsule endoscopy, OGD (with normal duodenal biopsies) and MRI of the spine were all normal. Also anti TTG antibodies were negative. She proceeded to have Left iliopsoas muscle block after liaising with the pain control team. This resulted in complete resolution of the pain. She began to regain the lost weight and her weight has remained stable at 49 kgs. This was a case of iliopsoas syndrome masquerading as a surgical pathology.