Appendicitis in patients with previous spinal cord injury

Strauther, Gregory R; Longo, Walter E.; Virgo, Katherine S.; Johnson, Frank E.

doi:10.1016/s0002-9610(99)00207-x

Cited by 27 publications

(34 citation statements)

References 13 publications

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“…Esophageal distension triggered pain in patients with cervical spinal cord transsection, which could be partly confounded by the more rostral projections of spinal esophageal afferents innervating the proximal esophagus [30]. Acute illnesses from appendicitis to cholecystitis may be more difficult to diagnose, but are still associated with abdominal pain in paraplegic individuals with thoracic or cervical lesions [31][32][33]. A case series of patients with complete spinal transsection at the level of the cervical cord (around C4) reported prolonged episodes of impaired gastric function after elective abdominal surgeries, typically manifesting with pain, bloating, nausea, and the inability to tolerate oral intake, a symptom complex similar to that described by our patient [34].…”

Section: Discussionmentioning

confidence: 99%

Pain without nociception?

Levinthal

Bielefeldt²

2012

European Journal of Gastroenterology & Hepatology

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We describe a young woman with complete cervical spinal cord transsection, who developed significant abdominal pain, triggered by gastric distension and deep abdominal palpation. On the basis of the nature of her spinal cord injury, her brain-gut axis was limited to vagal pathways. Studies in mammalian models of human visceral sensation consistently showed that the subdiaphragmatic vagus contains a homogeneous population of afferents that are activated by low-intensity stimuli, which are generally believed to be important in regulating autonomic function and perhaps contributing to visceral sensory experiences triggered by such low-intensity stimuli (e.g. fullness, nausea), but not pain, although many fibers encode stimuli well into the noxious range. In contrast, spinal afferent pathways include fibers with high-activation thresholds that are thought to represent specialized nociceptors. This illustrative case argues against an exclusive role of specialized nociceptive pathways in visceral pain, but supports a concept of intensity coding with the composite of vagal and spinal input contributing to conscious perception and pain.

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Section: Discussionmentioning

confidence: 99%

Pain without nociception?

Levinthal

Bielefeldt²

2012

European Journal of Gastroenterology & Hepatology

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“…Symptoms included abdominal distention (35%), abdominal discomfort (35%), fever (15%) emesis (8%), and shock (8%). 4 Additionally, a review of the acute abdomen in spinal cord injured individuals concluded that the most important signs were autonomic dysreflexia, referred shoulder tip pain, abdominal pain, abdominal distension, increased spasticity and abdominal pain with nausea and vomiting. 5,6 Our patient had a history of autonomic dysreflexia, although it did not seem to complicate this admission.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, computed tomography has been proven to be an excellent diagnostic modality in the SCI patient population. 4 Finally, if a patient becomes hemodynamically unstable, then acute measures need to be taken, and imaging studies to rule out other processes should be ordered in a timely manner. Although a thorough history and physical examination are the standard of care for any evaluation, in this particular set of circumstances, it appeared that appropriate imaging saved this patient's life.…”

Section: Discussionmentioning

confidence: 99%

An Occult Presentation of Appendicitis in a Patient with Tetraplegia

Zaremski

Jayawardena²,

Lew³

2010

American Journal of Physical Medicine &Amp; Rehabilitation

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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.

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“…Diagnoses are often so delayed that approximately 10% of these patients die of acute abdominal problems. 1 Strauther and associates 2 reviewed 26 patients with spinal cord injury who later developed appendicitis over a 5-year period. The 30-day mortality rate was 4%.…”

Section: Introductionmentioning

confidence: 99%

“…Computed tomography appeared to be an excellent diagnostic modality for diagnosis of perforated appendix with abscess. 1 Bar-On and Ohry 3 reviewed the occurrence of acute abdomen in 1300 patients with SCI, over 14-year period of 1978 ± 1991. The classical signs of an`acute abdomen' were missing in the patients with neurological levels above T-6. Similar to the cases of acute abdomen and acute appendicitis in SCI patients, the diagnosis of an acute illness of the urinary tract may be delayed in spinal cord injury patients.…”

Section: Introductionmentioning

confidence: 99%

Silent hydronephrosis/pyonephrosis due to upper urinary tract calculi in spinal cord injury patients

et al. 2000

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Study design: A study of four patients with spinal cord injury (SCI) in whom a diagnosis of hydronephrosis or pyonephrosis was delayed since these patients did not manifest the traditional signs and symptoms. Objectives: To learn from these cases as to what steps should be taken to prevent any delay in the diagnosis and treatment of hydronephrosis/pyonephrosis in SCI patients. Setting: Regional Spinal Injuries Centre, Southport, UK. Methods: A retrospective review of cases of hydronephrosis or pyonephrosis due to renal/ ureteric calculus in SCI patients between 1994 and 1999, in whom there was a delay in diagnosis.Results: A T-5 paraplegic patient had two episodes of urinary tract infection (UTI) which were successfully treated with antibiotics. When he developed UTI again, an intravenous urography (IVU) was performed. The IVU revealed a non-visualised kidney and a renal pelvic calculus. In a T-6 paraplegic patient, the classical symptom of¯ank pain was absent, and the symptoms of sweating and increased spasms were attributed to a syrinx. A routine IVU showed non-visualisation of the left kidney with a stone impacted in the pelviureteric junction. In two tetraplegic patients, an obstructed kidney became infected, and there was a delay in the diagnosis of pyonephrosis. The clinician's attention was focused on a co-existent, serious, infective pathology elsewhere. The primary focus of sepsis was chest infection in one patient and a deep pressure sore in the other. The former patient succumbed to chest infection and autopsy revealed pyonephrosis with an abscess between the left kidney and left hemidiaphragm and xanthogranulomatous in¯ammation of perinephric fatty tissue. In the latter patient, an abdominal X-ray did not reveal any calculus but computerised axial tomography showed the presence of renal and ureteric calculi. Conclusions: The symptoms of hydronephrosis may be bizarre and non-speci®c in SCI patients. The symptoms include feeling unwell, abdominal discomfort, increased spasms, and autonomic dysre¯exia. Physicians should be aware of the serious import of these symptoms in SCI patients. Spinal Cord (2000) 38, 661 ± 668

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Appendicitis in patients with previous spinal cord injury

Cited by 27 publications

References 13 publications

Pain without nociception?

Pain without nociception?

An Occult Presentation of Appendicitis in a Patient with Tetraplegia

Silent hydronephrosis/pyonephrosis due to upper urinary tract calculi in spinal cord injury patients

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