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Ileal perforation in a patient with high spinal cord injury: report of a case

Atsushi Matsuo1, Yasuharu Tokuyama, Yosiki Hosono

  • 1Department of Surgery, Kanayama Hospital, 2594 Kanayama, Kanayama-cho, Mashita-gun, Gifu 509-1693, Japan.

Surgery Today
|January 10, 2004
PubMed

Insights

Diagnosing abdominal issues in spinal cord injury (SCI) patients is challenging due to masked symptoms. Early surgical intervention is crucial for small intestinal perforation in SCI survivors.

Area of Science:

  • Gastroenterology
  • Neurology
  • Trauma Surgery

Background:

  • High spinal cord injury (SCI) significantly impairs abdominal wall function, complicating the diagnosis of acute abdominal conditions.
  • Loss of sensory, motor, and reflex function can mask classic signs like tenderness and rigidity in SCI patients.
  • Abdominal complications in SCI survivors require heightened clinical suspicion and tailored diagnostic approaches.

Observation:

  • A 77-year-old male with a C6-7 spinal cord injury (SCI) sustained 14 years prior presented with a small intestinal perforation.
  • Despite absent abdominal wall sensation, an acute abdominal condition was accurately diagnosed.
  • Diagnostic challenges in SCI patients underscore the need for vigilance.

Findings:

  • An emergency laparotomy revealed a 1-cm perforation in the ileum, approximately 180 cm distal to the Treitz ligament.
  • Surgical management involved resection of 40 cm of affected ileum and end-to-end anastomosis.
  • Successful diagnosis and treatment were achieved despite neurological deficits.

Implications:

  • This case highlights the critical need for early surgical consultation and intervention for abdominal emergencies in SCI patients.
  • Awareness of masked symptoms in SCI is essential for timely and effective management of gastrointestinal complications.
  • Prompt diagnosis and treatment can improve outcomes for spinal cord-injured individuals experiencing abdominal pathology.

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