Atypical cause of radiating leg pain: Visceral referred pain due to ulcerative colitis

Abstract

Radiating leg pain can arise from a variety of etiologies in clinical practice, the most prevalent being neuropathic or musculoskeletal in origin. In rare cases an intra-abdominal pathology may also be the underlying cause. A case is reported of a 30-year old female patient who presented with neuropathic pain in the left groin region, radiating to the left thigh since four months. The pain was ultimately attributed to visceral referred pain associated with underlying ulcerative colitis (UC). The pathophysiological mechanism behind visceral referred pain originating from the distal colon —a region potentially affected in inflammatory bowel diseases such as UC— is likely due to the convergent input of somatic and visceral (lumbar splanchnic) afferent fibers at the L1-L2 level of the lumbar spinal cord, causing referred pain to the L1 and L2 dermatomes, corresponding to the groin and thigh. In this case report, we aim to underline the possibility of referred visceral pain as an uncommon etiology in unexplained radiating leg pain and the importance of thorough medical history and diagnostic evaluation.