This post is an answer to the Case – Tingling Ache and Abdominal Wall Protrusion
A man aged 57 years, who had had herpes zoster 10 years previously, visited our emergency room with a tingling ache in his right lower back. Physical examination revealed neither eruption nor trauma on the body surface. However, an abdominal wall protrusion was observed on his right side, especially while he was standing (figure). Abdominal imaging using contrasted computer tomography did not reveal any abnormalities.
Abdominal pseudohernia is a rare (approx. 2% of zoster cases) motor complication of herpes zoster (HZ) caused by segmental paresis of abdominal muscles. It presents as a localized abdominal bulge, often mimicking a hernia, resulting from denervation. Critically, this bulge can precede the painful skin rash, causing diagnostic challenges.
