Diabetic amyotrophy (DA) with abdominal pain and unilateral herniation may relate to a rare but severe variant. It is often misdiagnosed leading to extensive work up for intra-abdominal pathologies. We performed a systematic review of literature to further delineate the clinical and laboratory features of patients presenting with this unique variant of DA.
A systematic electronic search of Medline, PubMed, and EMBASE for case reports, case series, and related articles of diabetic neuropathy published till April 2014 was carried out. Statistical analysis was performed using Microsoft Excel and SPSS software. To examine the relationship between HA1c and time to resolution; and duration of diabetes mellitus (DM) and time to resolution, bivariate correlation analysis was performed.
Sixteen cases of DA with abdominal herniation were identified. Average age at presentation was 62.38 years, all patients were males with type II Diabetes mellitus (DM). The average duration of diabetes was 5.92 years and the most common site was at or below the T5 level. Common complaints were abdominal pain (87.5 %), weight loss (83.3%) and peripheral neuropathy (most cases). Average hemoglobin A1C was 8.39% at the time of diagnosis. Electromyography showed denervation of muscle in 60% of cases. Most patients received symptomatic treatment with tricyclic antidepressants (63.6%) and had spontaneous resolution (mean- 180 days). There was no statistically significant correlation between HA1C and time to resolution (Pearson r=-0.02, P=0.97), or duration of DM and time to resolution (Pearson r=0.13, P=0.75).
This variant of DA with abdominal herniation was found to occur most commonly in elderly patients, exclusively in males with type II DM. It should be considered in the differential diagnosis for patients presenting with abdominal pain and unilateral herniation with longstanding DM. Tricyclic antidepressants seem to be effective for symptomatic relief and it usually has a good prognosis.