Third lumbar transverse process syndrome with acute abdominal pain as the main clinical manifestation: A case report.

Authors

Guangcheng Wei, Ningjuan Yan, Guodong Zhao, Tao Liu, Ming Chen, Weikai Qin, Yong Zhao

Published in

Medicine. Volume 105. Issue 42. Pages e51067. Oct 16, 2026.

Abstract

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.
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.
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.
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.
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.
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.

PMID:
42888575
Bibliographic data and abstract were imported from PubMed on 17 Oct 2026.

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