General surgery problems in patients with spinal cord injuries

Area of Science:

• Neurology
• Gastroenterology
• Trauma Surgery

Background:

• Spinal cord injuries (SCI) can alter visceral pain perception and autonomic responses.
• Understanding these altered responses is crucial for timely diagnosis of intra-abdominal pathologies in SCI patients.

Purpose of the Study:

• To correlate the level and completeness of spinal cord lesions with patient responses to intra-abdominal disease.
• To identify diagnostic challenges and key clinical signs in SCI patients with acute abdominal conditions.

Main Methods:

• Studied 24 patients with varying levels and completeness of spinal cord injuries.
• Analyzed patient responses, pain localization, and clinical signs in relation to intra-abdominal pathology.
• Correlated findings with lesion level (cervical, thoracic, lumbar) and completeness (complete vs. incomplete).

Main Results:

• Complete cervical and upper thoracic (C4-T6) lesions often presented with non-localized abdominal pain and autonomic dysreflexia.
• Pain localization improved earlier in patients with incomplete lesions or lower thoracic/lumbar (T7-L3) lesions.
• Delayed diagnoses were common, except for upper gastrointestinal bleeding. Increased pulse rate was the most consistent objective finding.

Conclusions:

• The level and completeness of spinal cord lesions significantly influence the presentation of intra-abdominal disease.
• Early recognition of autonomic dysreflexia and increased pulse rate are critical for diagnosing abdominal pathology in SCI patients.
• Shoulder pain is a valuable indicator in quadriplegic patients with intra-abdominal issues.