Presentation
Lower right abdominal pain. Previous hysterectomy (6 months ago).
Patient Data
The appendix is normal without any signs of inflammation.
There is a lumbosacral transitional vertebra. On the right side, the transverse process of the L5 vertebra is enlarged with pseudo articulation with the sacrum, according to Castellvi classification IIa type – a possible cause of the right–side lower pain – Bertolotti syndrome.
After a few days CT–guided injection was done (1 mL Kenalog-40 and 1 mL bupivacaine), which had diagnostic and therapeutic indications. After that procedure, the pain was relieved.
Case Discussion
Bertolotti syndrome is a congenital disorder when there is a lumbosacral transitional vertebra with an enlarged transverse process, articulation with the sacrum, in the presence of low back pain.
If it is right-sided, the clinical features can mimic either appendicitis or Crohn's disease. In this case, there are no CT signs of appendicitis or Crohn's disease. After the injection, the pain relief confirmed the diagnosis of Bertolotti syndrome.