Third lumbar transverse process syndrome with acute abdominal pain as the main clinical manifestation: A case report.
- 1Sports Medicine Department, Wangjing Hospital, China Academy of China Medical Sciences, Chaoyang District, Beijing, China.
- 2Department of Spleen and Stomach Diseases, Wangjing Hospital, China Academy of Chinese Medical Sciences, Chaoyang District, Beijing, China.
Abstract
Rationale
Third lumbar transverse process syndrome is an uncommon musculoskeletal cause of referred abdominal pain. Because acute abdominal pain is appropriately evaluated first for visceral, vascular, urinary, and surgical emergencies, a spinal or paraspinal pain generator may be overlooked.Patient concerns
A 66-year-old man presented with persistent left lower-quadrant abdominal pain radiating to the left lower back. Baseline pain intensity was 7/10 on a VAS, and the pain was aggravated by postural change, standing, and walking.Diagnoses
Serial laboratory tests, endoscopy, ultrasonography, CT/CTA, and specialist consultations did not identify a visceral, urinary, surgical, or hemodynamically significant vascular disorder sufficient to explain the pain. Targeted musculoskeletal examination showed focal tenderness and increased soft-tissue tension around the left L3 transverse process, movement-related pain, and a visually estimated compensatory apparent leg-length discrepancy. These findings supported a clinical diagnosis of third lumbar transverse process syndrome presenting as referred abdominal pain.Interventions
The patient received Tuina manual therapy, two acupotomy closed-release procedures at palpation-defined tender points in the left lumbar and gluteal regions, and adjunctive pharmacotherapy.Outcomes
At discharge on February 9, 2021, the abdomen was soft without tenderness or rebound tenderness. Abdominal pain had resolved completely at the 2-week follow-up. Routine annual telephone follow-up of former inpatients was then conducted once yearly for 3 years, with no recurrence reported.Lessons
After urgent abdominal and vascular disorders have been excluded, history taking and targeted examination of the lumbar transverse processes may identify a musculoskeletal source of otherwise unexplained abdominal pain.
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BibTeX
@article{wei2026third,
title = {{Third lumbar transverse process syndrome with acute abdominal pain as the main clinical manifestation: A case report.}},
author = {Guangcheng Wei and Guangcheng Wei and Ningjuan Yan and Guodong Zhao and Tao Liu and Ming Chen and Weikai Qin and Yong Zhao},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051067},
url = {https://europepmc.org/article/MED/42888575},
note = {CC BY},
}
RIS
TY - JOUR
TI - Third lumbar transverse process syndrome with acute abdominal pain as the main clinical manifestation: A case report.
AU - Guangcheng Wei
AU - Guangcheng Wei
AU - Ningjuan Yan
AU - Guodong Zhao
AU - Tao Liu
AU - Ming Chen
AU - Weikai Qin
AU - Yong Zhao
PY - 2026
DA - 2026/10/01
JO - Medicine
DO - 10.1097/md.0000000000051067
UR - https://europepmc.org/article/MED/42888575
AB - Rationale Third lumbar transverse process syndrome is an uncommon musculoskeletal cause of referred abdominal pain. Because acute abdominal pain is appropriately evaluated first for visceral, vascular, urinary, and surgical emergencies, a spinal or paraspinal pain generator may be overlooked.Patient concerns A 66-year-old man presented with persistent left lower-quadrant abdominal pain radiating to the left lower back. Baseline pain intensity was 7/10 on a VAS, and the pain was aggravated by postural change, standing, and walking.Diagnoses Serial laboratory tests, endoscopy, ultrasonography, CT/CTA, and specialist consultations did not identify a visceral, urinary, surgical, or hemodynamically significant vascular disorder sufficient to explain the pain. Targeted musculoskeletal examination showed focal tenderness and increased soft-tissue tension around the left L3 transverse process, movement-related pain, and a visually estimated compensatory apparent leg-length discrepancy. These findings supported a clinical diagnosis of third lumbar transverse process syndrome presenting as referred abdominal pain.Interventions The patient received Tuina manual therapy, two acupotomy closed-release procedures at palpation-defined tender points in the left lumbar and gluteal regions, and adjunctive pharmacotherapy.Outcomes At discharge on February 9, 2021, the abdomen was soft without tenderness or rebound tenderness. Abdominal pain had resolved completely at the 2-week follow-up. Routine annual telephone follow-up of former inpatients was then conducted once yearly for 3 years, with no recurrence reported.Lessons After urgent abdominal and vascular disorders have been excluded, history taking and targeted examination of the lumbar transverse processes may identify a musculoskeletal source of otherwise unexplained abdominal pain.
SN - 0304-5412
SN - 1536-5964
ER -