Acute abdominal emergencies during the first four weeks after spinal cord injury

Diagnosing acute abdominal emergencies during spinal shock can be extremely difficult. Generally, the abdominal examination of an acutely cord-injured patient will not change with abdominal pathology. Loss of sensory, motor, and reflex functions mask typical signs. Nine hundred and forty-five medical charts were retrospectively examined to determine the incidence, causes, and risk factors for acute abdominal pathology during the first four weeks after spinal cord injury. Time of greatest risk was also investigated. Intraabdominal pathology was seen in 4.7% of the cases. Patients with complete cord lesions above the T5 level were most at risk. Respiratory distress was an additional risk factor for peptic ulcer disease. Decadron was found to be associated with pancreatitis but not with ulcers. Both pancreatitis and upper gastrointestinal hemorrhage appeared as early as three days postinjury. Findings of this study, as well as an understanding of the pathophysiology, symptomatology, and proper diagnostic workup assist in making the critical diagnosis.