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A silent acute abdomen in a patient with spinal cord injury

Rishi Malhotra1, Gerard Ee, Si Ying Pang

  • 1Department of Orthopaedics, National University Hospital, Singapore.

BMJ Case Reports
|March 29, 2013
PubMed

Insights

A man with cervical spondylosis developed central cord syndrome after a neck injury. Complications included bacterial infection, colitis, and abdominal perforation, but he achieved full neurological recovery.

Area of Science:

  • Neurology
  • Infectious Disease
  • Spinal Surgery

Background:

  • Cervical spondylosis predisposes individuals to neurological deficits following hyperextension injuries.
  • Central cord syndrome is a distinct neurological outcome following spinal trauma.

Observation:

  • A patient with cervical spondylosis developed central cord syndrome post-injury.
  • He experienced Streptococcus anginosus bacteremia, leading to pseudomembranous colitis.
  • Neurological deterioration prompted imaging, revealing C5-C7 discitis requiring surgical intervention.

Findings:

  • The patient underwent discectomy, debridement, and fusion for C5-C7 discitis.
  • An ascending colon perforation, initially masked by spinal cord injury symptoms, necessitated a right hemicolectomy.
  • Despite multiple complications, the patient achieved complete neurological recovery within one year.

Implications:

  • This case highlights the complex interplay between spinal cord injury and systemic complications.
  • It underscores the importance of vigilant diagnosis and management in patients with severe trauma and co-existing infections.
  • Successful surgical and medical management can lead to significant neurological recovery even after severe spinal cord injury and associated morbidities.

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