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Upper gastrointestinal bleeding in a quadriplegic patient

R S Djergaian, W E Staas

    Archives of Physical Medicine and Rehabilitation
    |July 1, 1981
    PubMed
    Summary

    Quadriplegic patients experiencing nausea and vomiting may develop upper gastrointestinal bleeding due to esophageal tears, similar to Mallory-Weiss syndrome. This case highlights a potential diagnostic consideration in patients with impaired abdominal muscle function.

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    Area of Science:

    • Gastroenterology
    • Neurology
    • Critical Care Medicine

    Background:

    • Gastrointestinal (GI) bleeding is a common clinical problem.
    • Mallory-Weiss syndrome, characterized by esophageal tears, is a known cause of upper GI bleeding.
    • Quadriplegia presents unique physiological challenges, including impaired abdominal muscle function.

    Observation:

    • An unusual case of upper GI bleeding occurred in a quadriplegic patient after nausea and vomiting.
    • Endoscopy revealed a tear in the distal esophagus, consistent with Mallory-Weiss syndrome.
    • The patient had quadriplegia, indicating a lack of functional abdominal muscles.

    Findings:

    • Vomiting physiology involves abdominal muscle contraction, which is impaired in quadriplegic patients.

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  • This impairment may alter the pathophysiology of vomiting-induced esophageal injury.
  • Esophageal mucosal tears should be considered in the differential diagnosis of upper GI bleeding in quadriplegic individuals.

    • Implications:

    • This case expands the understanding of upper GI bleeding etiologies in neurologically impaired patients.
    • It suggests a need to consider esophageal mucosal tears in quadriplegic patients presenting with GI bleeding.
    • Further research may elucidate the specific mechanisms of esophageal injury in this population.