Use of intrathecal drug infusion pump with combined morphine and bupivacaine medication for the treatment of abdominal pain due to Acute Intermittent Porphyria (AIP)

Abstract

Porphyrias consist of nine genetic disorders, acquired or congenital, resulting from failures in the biosynthesis process of the heme group, resulting in the accumulation of metabolic intermediates in the human body, causing toxicity. We describe a case of a 32-years-old Woman presented with severe and continual abdominal pain, presenting a visual analog scale (VAS) score of 9-10, described by the patient as the worst pain she has ever felt in her life, colic type in the mesogastric area and that radiated throughout the entire abdomen for six months. Due to the presented condition, she underwent appendectomy and cholecystectomy procedures, being later diagnosed with acute intermittent porphyria (AIP). It is important to highlight that some manifestations resulting from AIP are similar to Acute Abdomen. This is a clinical condition characterized by sudden or progressive abdominal pain, which usually requires an emergency surgical procedure to resolve the condition. The diagnosis of AIP is quite complex, and it can easily cause misdiagnoses, as in the present case report, in which the patient was mistakenly submitted to appendectomy and cholecystectomy procedures, due to the symptom of severe abdominal pain, which could lead to exposure her to iatrogenic damage.