Massive gastroduodenal hemorrhage and perforation in acute spinal cord injury

Fatal gastrointestinal hemorrhage or perforation are important problems in the management of patients in the acute phase of spinal cord injury. This paper describes 3 patients with these conditions, and shows some of the associated hazards, especially the danger of painless penetration, perforation, and peritonitis, plus the increased morbidity of these serious problems in the presence of the neurological sequelae of spinal cord injury. Our experience shows that life-threatening hemorrhage from the gastrointestinal tract occurs in about 2.5% of patients with cord injury, and often occurs during the first few days after the accident. We believe that a high index of suspicion and an aggressive therapeutic approach are necessary to save these patients from the traditionally high mortality associated with massive upper gastrointestinal hemorrhage, especially during this critical period of acute spinal cord injury.