Case of Acute Pancreatitis Masquerading as Intercostal Neuralgia


A patient presented to the clinic complaining of acute and dull pain in the thoracic spine area, radiating to the right and left intercostal region.


The patient also experienced general weakness, anxiety, irritability, and insomnia. The pain worsened in the evening and at night, attributed to a sedentary lifestyle.

Medical History

The patient had been experiencing pain in the thoracic and lumbar spine for a while but had not sought treatment. Recently, the pain worsened, prompting him to seek medical help. He was initially diagnosed with intercostal neuralgia and prescribed nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, B vitamins, local glucocorticoid blockade, including Dexamethasone, massage, and physiotherapy. However, the effect was short-lived, leading him to consult an osteopath.

According to the patient, he had no family history of similar conditions.


The patient appeared irritable and assumed forced positions to alleviate pain. Physical examination revealed excess weight, facial swelling, and redness. Deep inhalation and bending caused discomfort and pain. Palpation of the thoracic spine’s spinous processes and the right and left intercostal areas elicited pain.

The patient had tenderness in the zones associated with the pancreas, gallbladder, stomach, and biliary tract. Pain also occurred upon palpation of the duodenum and the area above the clavicle.

The patient brought an MRI scan of the spine, indicating thoracic osteochondrosis. Following examination, a CT scan of the abdominal organs revealed extensive changes in pancreatic tissue and chronic cholecystitis.


Acute pancreatitis (inflammation of the pancreas).
Osteochondrosis. Thoracic spine dorsopathy.


The patient was prescribed:
• Diet – table No. 5, excluding alcohol, sugar, fried, and fatty foods;
• Enzymes and cholagogic drugs;
• Three sessions of osteopathic techniques on the visceral area and thoracic spine, with one session per week.

After three weeks, the pain significantly subsided.

The patient was advised to continue the diet and return for a follow-up appointment in a month.


This clinical case underscores the challenge of differentiating between spinal and peri-spinal tissue diseases and internal organ pathologies. In this instance, correctly diagnosing the condition was challenging due to the severity of the pain, which is typically not as intense in pancreatitis cases. Further examination revealed that the symptoms were primarily linked to pancreatic inflammation. Proper diet, medication, and osteopathic correction significantly improved the patient’s condition.