Third lumbar transverse process syndrome with acute abdominal pain as the main clinical manifestation: A case report.
Guangcheng Wei, Ningjuan Yan, Guodong Zhao et al.
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Case in brief
A 66-year-old man presented with persistent left lower-quadrant abdominal pain radiating to the lower back, worsened by postural change, standing, and walking. Serial investigations and specialist assessments did not identify a visceral, urinary, surgical, or significant vascular cause. Targeted examination found focal tenderness and increased soft-tissue tension around the left L3 transverse process, movement-related pain, and an apparent leg-length discrepancy, supporting a clinical diagnosis of third lumbar transverse process syndrome with referred abdominal pain. After manual therapy, two acupotomy procedures, and adjunctive medication, the pain had resolved at 2-week follow-up; no recurrence was reported during 3 years of annual telephone follow-up.
What made this case unusual
The syndrome presented chiefly as acute abdominal pain, with pain provoked by movement and focal L3 findings helping identify a musculoskeletal source after abdominal and vascular investigations were unrevealing.
Diagnostic / clinical pearl
When urgent abdominal and vascular causes have been excluded, assess the lumbar transverse processes and surrounding soft tissues in patients with unexplained abdominal pain, particularly when symptoms vary with movement.