An Occult Presentation of Appendicitis in a Patient with Tetraplegia

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.

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

“…Diagnosing acute abdomen in the general population is sometimes difficult and delayed because of the nonspecific early symptoms. 1 In SCI patients, diagnosing acute abdomen is even more difficult which can result in delayed surgical management. 1,2 In fact, approximately 33% of SCI patients experience a significant delay in their diagnoses.…”

“…1 In SCI patients, diagnosing acute abdomen is even more difficult which can result in delayed surgical management. 1,2 In fact, approximately 33% of SCI patients experience a significant delay in their diagnoses. 1,3 Delayed diagnosis has been associated with mortality rates of 4% to 17% and morbidity rates of 30% to 50%.…”

“…1,2 In fact, approximately 33% of SCI patients experience a significant delay in their diagnoses. 1,3 Delayed diagnosis has been associated with mortality rates of 4% to 17% and morbidity rates of 30% to 50%. [2][3][4][5][6][7][8] Normal somatic sensation for the anterior abdominal wall originates from T7 to T12 and L1.…”

“…2,3,5 Because patients with SCI above this level have a disruption of the normal sensory pathways from the anterior abdominal wall and abdominal viscera, early symptoms and the typical signs of an acute abdomen, such as abdominal muscle rigidity, tenderness, and rebound tenderness, are often absent. 1,8 Sometimes, pyrexia and leukocytosis are also absent. 8 In previous studies, 33% to 55% of SCI patient with acute abdomen had leukocytosis, and 32% to 81% had as so cia ted f evers .…”