Ungewöhnlicher Grund für rezidivierende Bauchschmerzen bei einer adipösen 63-jährigen Patientin

HISTORY AND CLINICAL FINDINGS: A 63-year-old woman was admitted because of abdominal pain for 12 months, associated with an increasing abdominal distension. One month before a gastroscopy had revealed mild gastritis. The taking of proton pump inhibitors did not improve her symptoms. There was no relevant neurological or psychiatric past history. INVESTIGATIONS: Ultrasound and laboratory tests demonstrated a fatty liver and increased serum levels of lipoproteins. Magnetic resonance imaging revealed an increase in subcutaneous and intraperitoneal adipose tissue. Endoscopy did not show any additional significant findings. DIAGNOSIS AND TREATMENT: The patient had adiposis dolorosa. Initially she was given daily a combination of mexiletine 400 mg and 75 mg Amitriptyline. After a few days the ailment decreased and had disappeared completely after one week. Three months later the dosage was reduced to 100 mg mexiletine and 25 mg Amitriptyline daily. After another two months all medication was discontinued. At follow-up after 12 months the symptoms had not recurred. CONCLUSION: This case demonstrates that abdominal pain is not always caused by diseases of the visceral hollow organs. It must also be borne in mind that abdominal pain may be associated with adipose tissue, as is the case in adiposis dolorosa. The disease can be successfully treated, as in this case, using a combination of mexiletine and Amitriptyline.