Acute Abdomen in a Cervical Spinal Cord Injury Patient: A Case Report and Review of the Literature

Abstract

Acute abdomen, including appendicitis, is an emergent condition requiring early detection and, often, immediate surgical intervention. Although patients with spinal cord injury (SCI) have an incidence of acute abdomen similar to that of the general population, diagnosing them is even more difficult and complex than it is in the general population. Because of the disruption of normal sensory pathways, the early symptoms are subtle and physical examination of the abdomen is often not helpful. In addition, because of concomitant common conditions in SCI patients, such as urinary tract infection, atelectasis, pneumonia, and decubitus ulcer, laboratory results are not reliable. Delayed diagnoses lead to higher mortality rates among SCI patients with acute abdomen than those of the general population. We report a case of appendicitis in a patient with cervical SCI and discuss the clinical characteristics and diagnostic pitfalls of acute abdomen in SCI patients. (Hong Kong j.emerg.med. 2013;22:178-181) 急腹症，包括闌尾炎，是一個緊急情況，需要及早發現並常要立即動手術。雖然脊髓損傷( SCI )的 患者急腹症的發生率與總人口的相似，診斷卻比在普通人群中更為困難和複雜。由於正常的感覺神經系 統通路的中斷，早期的症狀並不明顯，腹部檢查往往也沒有幫助。此外，因為 SCI 患者經常伴隨著有如 尿路感染、肺不張、肺炎、褥瘡，實驗室檢測結果也是不可靠的。診斷延遲導致脊髓損傷患者比一般人 群急腹症死亡率較高。我們報告一例頸椎脊髓損傷的闌尾炎病人，並討論在 SCI 患者急腹症的臨床特點 和診斷陷阱。