A seizure-induced T8 burst fracture re-presenting as an acute abdomen

A male aged 44 years presented to the emergency department with a 1-week history of intermittent right-sided abdominal pain radiating to the midline. Examination demonstrated a tender right upper quadrant with voluntary guarding and a low grade fever. One week previously, he had been admitted to hos...

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Bibliographic Details
Published in:BMJ case reports 2017-05, Vol.2017, p.bcr-2017-220346
Main Authors: Smith, Radford Arran James, Poland, Nigel, Cope, Simon
Format: Article
Language:English
Subjects:
Abdomen
Abdomen, Acute - etiology
Adult
Back pain
Bone Screws
Diagnosis, Differential
Drug overdose
Emergency medical care
Humans
Injuries
Male
Seizures - complications
Spinal Fractures - complications
Spinal Fractures - diagnosis
Spinal Fractures - diagnostic imaging
Spinal Fractures - surgery
Thoracic Vertebrae
Tomography, X-Ray Computed
United Kingdom
Unusual Association of Diseases/Symptoms
Vertebrae
White
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Summary:A male aged 44 years presented to the emergency department with a 1-week history of intermittent right-sided abdominal pain radiating to the midline. Examination demonstrated a tender right upper quadrant with voluntary guarding and a low grade fever. One week previously, he had been admitted to hospital after an isolated, self-terminating seizure secondary to an deliberate venlafaxine overdose. His upper abdominal symptoms started immediately postseizure but at the time were attributed to musculoskeletal chest pain by the discharging team. Acute cholecystitis was suspected, but liver function tests, amylase and an erect chest radiograph were unremarkable.The abdominal pain responded well to morphine, permitting a thorough reassessment of the patient, which revealed midthoracic spine tenderness, previously undetected. Prior to this, the patient had not complained of any back pain. A CT scan confirmed a burst fracture of T8 requiring urgent transfer to the local spinal unit for posterior stabilisation.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2017-220346