{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T11:54:47Z","timestamp":1790682887312,"version":"4.1.0"},"reference-count":14,"publisher":"Grigore T. Popa University of Medicine and Pharmacy","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Clin Cases"],"abstract":"<jats:p>Refractory subcostal and abdominopelvic pain in undiagnosed hypermobile Ehlers-Danlos syndrome (hEDS) may lead to prolonged diagnostic odysseys and repeated surgery. We report a 48-year-old woman who met the 2017 clinical criteria for hEDS and developed persistent subcostal pain despite multiple operations for gynecologic disease, posterior Nutcracker syndrome, median arcuate ligament syndrome, xiphoid deformity, and slipping rib syndrome; anterior cutaneous nerve entrapment syndrome was later diagnosed. Imaging demonstrated a retro-aortic left renal vein, celiac trunk compression, and hypermobile false ribs. Pain recurred or persisted after each intervention, with only transient improvement after xiphoid resection and initial improvement after rib fixation followed by relapse. This case illustrates a multi-compression\/multi-entrapment phenotype in hEDS, in which connective tissue laxity may reduce the durability of anatomically targeted procedures. Early recognition of hEDS should prompt hypermobility-aware assessment and favor conservative, multidisciplinary management before further invasive treatment. Dynamic evaluation may help identify overlapping pain generators more accurately.<\/jats:p>","DOI":"10.22551\/2026.52.1303.10348","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T10:51:55Z","timestamp":1790679115000},"page":"98-102","source":"Crossref","is-referenced-by-count":0,"title":["Multiple surgical interventions for refractory subcostal pain in hypermobile Ehlers-Danlos syndrome: a case report spanning vascular, skeletal, and nerve entrapment diagnoses"],"prefix":"10.22551","volume":"13","author":[{"name":"Department of Biomedical Engineering, Faculty of Mechanical Engineering, TUKE - Technical University of Kos\u02c7ice, Slovakia; Asocia\u00b4cia Vaskula\u00b4rnych Kompres\u0131\u00b4vnych Syndro\u00b4mov a Ehlers-Danlos, o.z., Bratislava, Slovakia","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2979-7946","authenticated-orcid":false,"given":"Silvia","family":"\u0160i\u0161kov\u00e1","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3841-4806","authenticated-orcid":false,"given":"Talal","family":"Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"National Institute of Cardiovascular Diseases, Bratislava, Slovakia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"De\u00e1kov\u00e1","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"National Institute of Cardiovascular Diseases, Bratislava, Slovakia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"9837","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"\"1. Malfait F, Francomano C, Byers P, et al. The 2017 international classification of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet. 2017 Mar;175(1):8-26. doi: 10.1002\/ajmg.c.31552. PMID: 28306229.","DOI":"10.1002\/ajmg.c.31552"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"2. Henderson FC Sr, Austin C, Benzel E, et al. Neurological and spinal manifestations of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet. 2017 Mar;175(1):195-211. doi: 10.1002\/ajmg.c.31549. PMID: 28220607.","DOI":"10.1002\/ajmg.c.31549"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"3. D'Oria M, Zlatanovic P, Anthony A, et al. International Union of Angiology consensus document on vascular compression syndromes. Int Angiol. 2023 Aug;42(4):282-309. doi: 10.23736\/S0392-9590.23.05100-3. PMID: 37498053.","DOI":"10.23736\/S0392-9590.23.05100-3"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"4. Sandmann W, Scholbach T, Verginis K. 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PMID: 23095510.","DOI":"10.1159\/000343738"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"10. Castori M, Morlino S, Celletti C, et al. Re-writing the natural history of pain and related symptoms in the joint hypermobility syndrome\/Ehlers-Danlos syndrome, hypermobility type. Am J Med Genet A. 2013 Dec;161A(12):2989-3004. doi: 10.1002\/ajmg.a.36315. PMID: 24254847.","DOI":"10.1002\/ajmg.a.36315"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"11. Rombaut L, Malfait F, De Wandele I, et al. Medication, surgery, and physiotherapy among patients with the hypermobility type of Ehlers-Danlos syndrome. Arch Phys Med Rehabil. 2011 Jul;92(7):1106-12. doi: 10.1016\/j.apmr.2011.01.016. PMID: 21636074.","DOI":"10.1016\/j.apmr.2011.01.016"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"12. Foley Davelaar CM. A Clinical Review of Slipping Rib Syndrome. Curr Sports Med Rep. 2021 Mar 1;20(3):164-168. doi: 10.1249\/JSR.0000000000000821. 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