U.S. Department of Veterans Affairs.

No abstract

A 26-yr-old man with a C4 American Spinal Injury Association impairment scale B spinal cord injury was admitted due to a left calf pressure ulcer. The patient's initial laboratory results and physical examination findings were unremarkable, except for a stage IV pressure ulcer. On day 7, the patient developed fever and leukocytosis. A complete culture workup performed did not yield abnormalities. A computed tomography scan of the abdomen and pelvis revealed retrocecal appendicitis with a retrocecal abscess containing an appendicolith. The abscess was drained percutaneously, and the patient was given a 6-wk course of intravenous antibiotics. The patient returned to the hospital 30 days later for an appendectomy. Typical signs of appendicitis can be masked in patients with a spinal cord injury. It is crucial to include appendicitis in the differential diagnosis of this population, even though the presentation is as nonspecific as fever and leukocytosis.

Introduction: Persistent urethral incontinence occurs in approximately 30% of patients after ileovesicostomy. We report a case of a patient with neurogenic bladder dysfunction due to spinal cord injury managed with ileovesicostomy and an artificial urinary sphincter (AUS) to treat persistent incontinence. Methods: A case report with 2-year follow-up is presented after review of the computerized medical record. Results: Persistent urethral incontinence was eliminated after AUS treatment. However, due to de novo autonomic dysreflexia, nighttime deactivation of the device was required. Conclusions: To our knowledge this is the first case reported of an individual with neurogenic bladder dysfunction managed with an ileovesicostomy to limit elevated detrusor pressures and an AUS to control persistent urethral incontinence. The combination of these procedures appears to be a safe, effective, and less invasive option than an ileovesicostomy followed by bladder neck closure or conversion to ileal conduit. However, the possibility of de novo autonomic dysreflexia must be considered.