Gastric Dysmotility After Abdominal Surgery in Persons With Cervical Spinal Cord Injury: A Case Series

Abstract

Background: Spinal cord injury (SCI) has been found to affect the physiology of the gastrointestinal tract. Changes in gastric motility occur in tetraplegia because of dissociation of antral and duodenal motility. Among individuals with high-level tetraplegia, antral quiescence has been hypothesized as a manifestation of autonomic dysreflexia after surgery. This case series shows the issues with gastric hypomotility after gastrointestinal surgery in tetraplegic patients with tetraplegia, including management strategies. Objective: To report 3 patients with complete high cervical SCI who developed gastroparesis after abdominal surgery and discuss the effect of autonomic dysfunction on gastric motility. Methods: Retrospective chart review of 3 cases. Results: Gastroparesis occurred after abdominal surgery in 3 patients with C4 American Spinal Injury Association (ASIA) A tetraplegia and seemed to be a sign of autonomic hyperreflexia caused by postoperative pain. Management was challenging because it consisted of balancing of appropriate pain medication and dealing with absorption issues and dysmotility. Often gastric motility agents were not effective in improving gastric emptying. However, increased use of pain medication improved gastric emptying, which supports the hypothesis that this issue represents gastric dysfunction from autonomic hyperreflexia. Conclusions: In persons with complete cervical SCI who have undergone abdominal surgery, postoperative gastroparesis can be a manifestation of pain. This may occur as the excessive sympathetic response from autonomic hyperreflexia inhibits distal antral activity. Thus, treatment of postoperative gastroparesis should focus on improved pain control to decrease excessive splanchnic sympathetic output and circulating norepinephrine.

Pain without nociception?

“…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].…”

Headache attributed to autonomic dysreflexia

“…22,47,e7-e11 In addition to eliminating actionable triggers of autonomic dysreflexia, terazosin and prazosin have been used on a regular basis to prevent recurrent attacks. 44 An underrecognized entity. 44 An underrecognized entity.…”