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Rehabilitation Practice and Science

Translated Title

脊髓損傷後合併廻腸末端穿孔：病例報告

Abstract

The patient with a spinal cord lesion may not have the early signs of peritonitis such as pain, local tenderness and local muscular rigidity, therefore it is extremely difficult to make an early diagnosis of an acute abdominal lesion. Important clues to the underlying lesion may be found in referred pain, local or systemic spasticity, blood pressure and temperature variation, sweating patterns, changing abdominal sign.This was a 37 years old female who had hospitalized following a car accident which resulted in c7 complete quadriplegiac7 Two years later, she was admitted because of severe nausea, vomitting, profused sweating, poor appetite, general weakness, and increased spasticity of abdomen, and both lower extremities. Physical examination revealed mild rigid abdomen with decreased bowel sound. There was severe pain over both shoulders. Her blood pressure, heart rate and respiratory rate showed normal. Neurologic examination remained c7 quadriplegic. The complete blood count showed evidence of hemocon-centration. Urinalysis and chest roentgenogram were normal. Strong reaction of occult blood in stool was found. Emergency examination of abdominal computed tomography and sonography were performed and ascites were found. Abdominal tapping was performed under sonography quidance, about 5cc bloody ascites were aspirated. Emergency exploratory laparotomy was performed by surgeon. About 700cc brown yeellowish bloody ascites and necrotic tissue were removed. A perforated hole about 2.5 ─3.0 cm in diameter at the proximal part of the ileocecal valve was found. The ileum was resected about 50 cm in length including the perforated hole. The specimen was sent for pathologic examination, but there revealed no evidence of preexsisting ulcer nor malignancy. In reviewing the literature concerning the gastrointestinal emergency in spinal cord injured patients, this is the first casereported with perforation from the ileum.

Language

Traditional Chinese

First Page

99

Last Page

102

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