Abdominal Pain- Non-athlete

Abstract

HISTORY: A 48-year-old former pizza shop worker presents with >2 years of intermittent abdominal pain with extensive GI work up. Patient reports that pain is worse with bowel movements, tying shoes, bending over, and reaching with arms. Significant history of alcohol and cigarette use. He feels as if he is bruised or experienced a “Charlie horse” after these ~1 minute episodes occur. PHYSICAL EXAMINATION: Tenderness of right lower chest wall and right upper quadrant without guarding or rebound. Negative McBurney’s point and Murphy’s sign. Intermittent abdominal distention over the course of disease. Patient brought video showing abnormal chest wall movement to more recent appointment. DIFFERENTIAL DIAGNOSIS: 1. Slipping Rib Syndrome 2. GERD 3. Intercostal/Oblique muscle spasm TEST AND RESULTS: CT abdomen pelvis 9/30/19 No bowel obstruction or acute renal pathology. Mild fluid and air to distention of small-bowel loops without obstruction. The stomach is underdistended. Gastric wall thickening cannot be excluded. US Abdomen 1/24/17 Normal right upper quadrant ultrasound. EGD 7/2019 - Esophageal mucosal changes suspicious for short-segment Barrett's esophagus. Biopsied. - Normal antrum. Biopsied. - Granular gastric mucosa. Biopsied. - Normal duodenum. FINAL WORKING DIAGNOSIS: Slipping rib syndrome of right side TREATMENT AND OUTCOMES: Patient still seeing GI for possible GERD related causes. Awaiting follow up for referral to OMT clinic for manipulation. Diclofenac gel prescription for pain relief. If OMT and analgesic treatment unsuccessful, referral for surgical resection or intercostal nerve block