Colorectal disease in spinal cord patients

Abstract

Undiagnosed abdominal emergencies account for 10 percent of all fatalities among patients with spinal cord injuries. A large number of these emergencies involve the lower gastrointestinal tract. The purpose of this study is to bring attention to the occult nature of colorectal disease in spinal cord patients and to highlight the subtle, but characteristic, symptoms and signs that develop in these patients. The authors identified 13 spinal cord patients in whom a lesion developed in either the appendix, colon, rectum, or anus. The average age of all patients was 36.2 years. Trauma and multiple sclerosis were the most common etiology of spinal cord injury. The most common presenting symptoms were abdominal distention, vomiting, and constipation. The average delay in diagnosis of the colorectal disease was 35.8 hours. An 84% morbidity and 22% mortality were observed. This study indicates that any deviation from the normal lifestyle of the spinal cord patient should alert one to the possibility of visceral inflammation. Furthermore, close attention to the signs of autonomic dysreflexia or changes in spasticity, along with a thorough evaluation of the ill-appearing spinal cord patient, may uncover occult colonic or rectal disease.

Colonoscopy after spinal cord injury: a case–control study

“…13,15 Established CRC population screening guidelines are of limited utility given the high frequency of gastrointestinal complaints. 7 Clinical examination is challenging, resource-dependant, unreliable 16 and insufficient to exclude CRC. The occurrence of rectal bleeding in the majority should preclude the use of faecal occult blood test as a screening test.…”

Lidocaine Anal Block Limits Autonomic Dysreflexia During Anorectal Procedures in Spinal Cord Injury: A Randomized, Double-Blind, Placebo-Controlled Trial

“…5,17,19 However, the common association of SCI with anal and colorectal problems 16,[20][21][22] ensures frequent contact between colorectal surgeons and the SCI population, and thus the need for awareness in our community of the possibility of triggering AD with a procedure.…”

Bowel management outcomes in individuals with long-term spinal cord injuries

“…The frequent misperception that there is little serious morbidity or mortality associated with bowel dysfunction, coupled with the diagnostic di culties created by SCI survivor's lack of sensation and mobility, 9 may account for some of this disinterest.…”

“…7 Seemingly, few other studies have tracked GI disturbances and their frequency in long-injured populations, and few have examined the impact that bowel management technique has on reported complications ± despite the fact that such information could permit SCI survivors to make the changes and interventions necessary to avert more medically intensive treatment. 9 This descriptive study, therefore, examines the association of bowel management techniques with bowel complications, as well as analyzing the e ects of both age and duration of injury in individuals who have been spinal cord injured for 20 or more years.…”