A silent acute abdomen in a patient with spinal cord injury

BMJ Case Rep, 2013 · DOI: 10.1136/bcr-2013-008548 · Published: January 1, 2013

Spinal Cord Injury Surgery Research Methodology & Design

Simple Explanation

A 52-year-old man with a spinal cord injury developed an ascending colon perforation, which was initially missed due to the altered sensation caused by his injury. This case highlights the difficulties in diagnosing acute abdominal issues in patients with spinal cord injuries. The patient's initial injury was compounded by a dental infection leading to bacteraemia and subsequent antibiotic-induced colitis, further complicating the diagnosis of the perforation. The typical signs and symptoms of an acute abdomen, such as pain and tenderness, were absent, leading to a delay in diagnosis and highlighting the need for a high index of suspicion in SCI patients.

Study Duration

Not specified

Participants

One 52-year-old man

Evidence Level

Level 4: Case Report

Key Findings

1
Spinal cord injury can mask the typical signs and symptoms of an acute abdomen, making diagnosis challenging.
2
A high index of suspicion is crucial when evaluating SCI patients for acute abdominal pathology, even in the absence of pain or tenderness.
3
Radiological imaging plays a vital role in diagnosing acute abdominal conditions in SCI patients due to the altered presentation.

Research Summary

A 52-year-old man with cervical spondylosis sustained a hyperextension injury to the neck and subsequently developed central cord syndrome after 2 weeks. Owing to his spinal cord injury, an abdominal perforation was initially missed owing to the lack of clinical features of an acute abdomen. By one year follow-up he had returned to full neurological function.

Practical Implications

Increased Awareness

Clinicians should be aware of the potential for silent acute abdomen in SCI patients.

Diagnostic Vigilance

Maintain a high index of suspicion and utilize imaging liberally in SCI patients with abdominal complaints.

Prompt Intervention

Early diagnosis and intervention are critical to improving outcomes in SCI patients with acute abdominal pathology.

Study Limitations

1
Single case report limits generalizability.
2
The exact timing of the perforation is unclear.
3
Difficult to determine the impact of individual pathologies on the patient's overall condition.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury