Acute Spontaneous Perforation of Rectosigmoid Junction in a Patient with Quadriplegia following Spinal Cord Injury

Abstract

Background. Patients with cervical spinal injury with quadriplegia are at an increased risk of developing serious gastrointestinal complications. We report an unusual case of spontaneous rectosigmoid perforation in a quadriplegic patient. Case Presentation. A 58-year-old man with diabetes mellitus and hypertension presented to the emergency department following a fall from 25 feet of height. He sustained a fifth cervical vertebral fracture with quadriplegia and neurogenic shock. One week later, he developed progressive abdominal distension with tachycardia, low blood pressure, and respiratory distress. His abdomen was soft but had impaired liver dullness. Imaging showed evidence of visceral perforation. He underwent an emergency laparotomy and was found to have a perforation of the antemesenteric border of the rectosigmoid junction with fecal contamination. The perforation was repaired primarily, and a temporary loop ileostomy was created. The patient received intensive care for 4 days, and thereafter, the recovery was uneventful. He was later transferred to the spinal unit for further management. The intraoperative findings, histology, and subsequent colonoscopy did not reveal any underlying cause for the perforation. Conclusions. Clinical signs and symptoms are generally absent in patients following spinal cord injury, and the diagnosis of serious gastrointestinal pathology can be difficult and challenging. We believe that ischemia at the rectosigmoid junction precipitated by multiple factors was the possible reason for the spontaneous perforation.

Stercoral Ulcer Presenting in a Patient with Cauda Equina Syndrome Secondary to Postoperative Epidural Hematoma

“…It was reported that the risk of natural perforation secondary to paralytic enteritis is 3%, and the mortality rate is 50% [ 3 ]. Additionally, recent articles in the literature have reported that ischemia at the rectosigmoid junction is precipitated by multiple factors and might be a possible reason for the spontaneous perforation [ 6 ].…”

“…served [5]. A recent case report documented an occurrence of acute spontaneous perforation at the rectosigmoid junction in a patient with quadriplegia following a spinal cord injury [6]. Moreover, sacral root palsy related to cauda equina syndrome (CES) can lead to deterioration of fecal impaction [7].…”

“…In addition, in patients with spinal cord syndrome, adynamic bowel dysfunction, weak abdominal muscles, impaired rectal sensation, and delayed colonic transit time are commonly observed [ 5 ]. A recent case report documented an occurrence of acute spontaneous perforation at the rectosigmoid junction in a patient with quadriplegia following a spinal cord injury [ 6 ]. Moreover, sacral root palsy related to cauda equina syndrome (CES) can lead to deterioration of fecal impaction [ 7 ].…”