Yonsei Med J.  2005 Dec;46(6):870-873.

Abdominal Epilepsy and Foreign Body in the Abdomen - Dilemma in Diagnosis of Abdominal Pain

• Topno N
• Gopasetty
• Kudva A
• Lokesh B

Abstract

There are many medical causes of abdominal pain; abdominal epilepsy is one of the rarer causes. It is a form of temporal lobe epilepsy presenting with abdominal aura. Temporal lobe epilepsy is often idiopathic, however it may be associated with mesial temporal lobe sclerosis, dysembryoplastic neuroepithelial tumors and other benign tumors, arterio-venous malformations, gliomas, neuronal migration defects or gliotic damage as a result of encephalitis. When associated with anatomical abnormality, abdominal epilepsy is difficult to control with medication alone. In such cases, appropriate neurosurgery can provide a cure or, at least, make this condition easier to treat with medication. Once all known intra-abdominal causes have been ruled out, many cases of abdominal pain are dubbed as functional. If clinicians are not aware of abdominal epilepsy, this diagnosis is easily missed, resulting in inappropriate treatment. We present a case report of a middle aged woman presenting with abdominal pain and episodes of unconsciousness. On evaluation she was found to have an intra-abdominal foreign body (needle). Nevertheless, the presence of this entity was insufficient to explain her episodes of unconsciousness. On detailed analysis of her medical history and after appropriate investigations, she was diagnosed with temporal lobe epilepsy which was treated with appropriate medications, and which resulted in her pain being relieved.

Keyword

Abdominal pain; foreign body; temporal lobe epilepsy

MeSH Terms

Radiography, Abdominal
Humans
Foreign Bodies/pathology/*radiography
Female
Epilepsy, Temporal Lobe/*diagnosis/drug therapy
Electroencephalography
Anticonvulsants/therapeutic use
Adult
Abdominal Pain/drug therapy/*etiology/*radiography
*Abdomen

Figure

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  Fig. 1 Intravenous urogram showing normal kidneys and ureters. Foreign body in the abdomen (needle) is seen on the left side of the spine.

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  Fig. 2 Lateral view X-ray showing foreign body in the peritoneal cavity.

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  Fig. 3 Needle discovered at surgery.

Reference

1. Agrawal P, Dhar NK, Bhatia MS, Malik SC. Abdominal epilepsy. Indian J Pediatr. 1989. 56:539–541.

2. Benbadis SR. Wyllie E, editor. Epileptic seizures and syndromes. Neurologic Clinics. 2001. Philadelphia: Saunders;254–255.

3. Shorvon SD. Hand book of epilepsy treatment. 2000. Oxford: Blackwell Science;12.

4. Dangayach KK, Gupta OP, Bhargava SK, Udavat M, Singh H. Surgical complications of left over intraperitoneal foreign body. Ind J Surg. 1984. 46:84–87.

5. Dukalska D, Stankowski A, Gurda L, Zabska G. 20-year presence of a foreign body in the retroperitoneal space. Wiad Lek. 1987. 40:901–903.