Colonic obstruction in a tetraplegic patient: a common symptom from an uncommon cause

Spinal Cord Series and Cases, 2020 · DOI: https://doi.org/10.1038/s41394-020-0305-6 · Published: June 17, 2020

Spinal Cord Injury Gastroenterology Research Methodology & Design

Simple Explanation

Diagnosing acute abdominal conditions in people with spinal cord injuries (SCI) is challenging due to altered sensation and other health issues. This can lead to misdiagnosis and delayed treatment. This case report describes a man with tetraplegia (paralysis of all four limbs) who experienced nausea, vomiting, and abdominal swelling. His condition was initially misdiagnosed due to electrolyte imbalances. The man was eventually diagnosed with sigmoid volvulus (twisting of the sigmoid colon), which was detected using a CT scan. Early imaging is crucial for people with SCI who show signs of abdominal problems.

Study Duration

Not specified

Participants

A 57-year-old male with C4 AIS C tetraplegia

Evidence Level

Level 4; Case Report

Key Findings

1
The patient presented with nausea, vomiting, abdominal distension, and feeding intolerance, initially leading to a diagnosis of pseudo-gut obstruction due to severe hyponatremia.
2
A CT scan revealed sigmoid volvulus with a patent ileocaecal valve after conservative treatment failed, highlighting the importance of early imaging in SCI patients with abdominal symptoms.
3
The case suggests that focusing solely on electrolyte imbalances can delay the diagnosis of serious conditions like sigmoid volvulus in tetraplegic patients.

Research Summary

This case report highlights the difficulty in diagnosing acute abdominal conditions in patients with spinal cord injuries (SCI) due to altered sensation and multiple co-morbidities. A 57-year-old tetraplegic man presented with symptoms suggestive of colonic obstruction. Initial diagnosis focused on electrolyte imbalances, delaying the correct diagnosis of sigmoid volvulus. The authors conclude that early use of CT scans or MRI is preferable in SCI patients suspected of having an emergency intra-abdominal condition to avoid delays in diagnosis and treatment.

Practical Implications

Early Imaging

In patients with SCI presenting with abdominal symptoms, consider early CT or MRI to rule out surgical emergencies.

Differential Diagnosis

Maintain a broad differential for abdominal complaints in SCI patients, including mechanical obstruction, not just ileus or electrolyte imbalances.

Electrolyte Management

Be aware of the potential for hyponatremia (e.g., sertraline-induced) to mimic or mask other abdominal pathologies in SCI patients.

Study Limitations

1
Single case report limits generalizability
2
The specific contribution of sertraline to the patient's hyponatremia and colonic dysmotility is unclear.
3
Lack of detailed long-term follow-up data post-surgery.

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