Acute Spontaneous Perforation of Rectosigmoid Junction in a Patient with Quadriplegia following Spinal Cord Injury
Background. Patients with cervical spinal injury with quadriplegia are at an increased risk of developing serious gastrointestinal complications. We report an unusual case of spontaneous rectosigmoid perforation in a quadriplegic patient. Case Presentation. A 58-year-old man with diabetes mellitus a...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Case Reports in Surgery |
| Online Access: | http://dx.doi.org/10.1155/2020/8881840 |
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| author | Oshan Basnayake Chiran Rathnaweera Umesh Jayarajah Gishanthan Shanthamoorthy Heshan Dayantha Siriwardena Asela Jayathilaka |
| author_facet | Oshan Basnayake Chiran Rathnaweera Umesh Jayarajah Gishanthan Shanthamoorthy Heshan Dayantha Siriwardena Asela Jayathilaka |
| author_sort | Oshan Basnayake |
| collection | DOAJ |
| description | Background. Patients with cervical spinal injury with quadriplegia are at an increased risk of developing serious gastrointestinal complications. We report an unusual case of spontaneous rectosigmoid perforation in a quadriplegic patient. Case Presentation. A 58-year-old man with diabetes mellitus and hypertension presented to the emergency department following a fall from 25 feet of height. He sustained a fifth cervical vertebral fracture with quadriplegia and neurogenic shock. One week later, he developed progressive abdominal distension with tachycardia, low blood pressure, and respiratory distress. His abdomen was soft but had impaired liver dullness. Imaging showed evidence of visceral perforation. He underwent an emergency laparotomy and was found to have a perforation of the antemesenteric border of the rectosigmoid junction with fecal contamination. The perforation was repaired primarily, and a temporary loop ileostomy was created. The patient received intensive care for 4 days, and thereafter, the recovery was uneventful. He was later transferred to the spinal unit for further management. The intraoperative findings, histology, and subsequent colonoscopy did not reveal any underlying cause for the perforation. Conclusions. Clinical signs and symptoms are generally absent in patients following spinal cord injury, and the diagnosis of serious gastrointestinal pathology can be difficult and challenging. We believe that ischemia at the rectosigmoid junction precipitated by multiple factors was the possible reason for the spontaneous perforation. |
| format | Article |
| id | doaj-art-57198c288485410db34c397e8b213607 |
| institution | Kabale University |
| issn | 2090-6900 2090-6919 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Surgery |
| spelling | doaj-art-57198c288485410db34c397e8b2136072025-08-20T03:33:34ZengWileyCase Reports in Surgery2090-69002090-69192020-01-01202010.1155/2020/88818408881840Acute Spontaneous Perforation of Rectosigmoid Junction in a Patient with Quadriplegia following Spinal Cord InjuryOshan Basnayake0Chiran Rathnaweera1Umesh Jayarajah2Gishanthan Shanthamoorthy3Heshan Dayantha Siriwardena4Asela Jayathilaka5Department of Accident and Orthopedic Services, National Hospital of Sri Lanka, Colombo, Sri LankaDepartment of Accident and Orthopedic Services, National Hospital of Sri Lanka, Colombo, Sri LankaDepartment of Accident and Orthopedic Services, National Hospital of Sri Lanka, Colombo, Sri LankaDepartment of Accident and Orthopedic Services, National Hospital of Sri Lanka, Colombo, Sri LankaDepartment of Accident and Orthopedic Services, National Hospital of Sri Lanka, Colombo, Sri LankaDepartment of Accident and Orthopedic Services, National Hospital of Sri Lanka, Colombo, Sri LankaBackground. Patients with cervical spinal injury with quadriplegia are at an increased risk of developing serious gastrointestinal complications. We report an unusual case of spontaneous rectosigmoid perforation in a quadriplegic patient. Case Presentation. A 58-year-old man with diabetes mellitus and hypertension presented to the emergency department following a fall from 25 feet of height. He sustained a fifth cervical vertebral fracture with quadriplegia and neurogenic shock. One week later, he developed progressive abdominal distension with tachycardia, low blood pressure, and respiratory distress. His abdomen was soft but had impaired liver dullness. Imaging showed evidence of visceral perforation. He underwent an emergency laparotomy and was found to have a perforation of the antemesenteric border of the rectosigmoid junction with fecal contamination. The perforation was repaired primarily, and a temporary loop ileostomy was created. The patient received intensive care for 4 days, and thereafter, the recovery was uneventful. He was later transferred to the spinal unit for further management. The intraoperative findings, histology, and subsequent colonoscopy did not reveal any underlying cause for the perforation. Conclusions. Clinical signs and symptoms are generally absent in patients following spinal cord injury, and the diagnosis of serious gastrointestinal pathology can be difficult and challenging. We believe that ischemia at the rectosigmoid junction precipitated by multiple factors was the possible reason for the spontaneous perforation.http://dx.doi.org/10.1155/2020/8881840 |
| spellingShingle | Oshan Basnayake Chiran Rathnaweera Umesh Jayarajah Gishanthan Shanthamoorthy Heshan Dayantha Siriwardena Asela Jayathilaka Acute Spontaneous Perforation of Rectosigmoid Junction in a Patient with Quadriplegia following Spinal Cord Injury Case Reports in Surgery |
| title | Acute Spontaneous Perforation of Rectosigmoid Junction in a Patient with Quadriplegia following Spinal Cord Injury |
| title_full | Acute Spontaneous Perforation of Rectosigmoid Junction in a Patient with Quadriplegia following Spinal Cord Injury |
| title_fullStr | Acute Spontaneous Perforation of Rectosigmoid Junction in a Patient with Quadriplegia following Spinal Cord Injury |
| title_full_unstemmed | Acute Spontaneous Perforation of Rectosigmoid Junction in a Patient with Quadriplegia following Spinal Cord Injury |
| title_short | Acute Spontaneous Perforation of Rectosigmoid Junction in a Patient with Quadriplegia following Spinal Cord Injury |
| title_sort | acute spontaneous perforation of rectosigmoid junction in a patient with quadriplegia following spinal cord injury |
| url | http://dx.doi.org/10.1155/2020/8881840 |
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