Abstract
A man in his thirties visited our hospital with oliguria and abdominal distension. He suffered from numbness and motor palsy below the Th4-6 level due to a spinal cord injury caused by a traffic accident sustained 16 years previously. He was diagnosed as having urinary tract infection, and administered antibiotic treatment. However, his condition did not improve and he complained of nausea and several episodes of vomiting in the following few days. Abdominal CT was performed, and perforation of the sigmoid colon and leakage of stools into the abdominal cavity were detected. However, the patient did not show any typical signs or symptoms of peritonitis, such as tenderness, muscle rigidity, or rebound tenderness. Emergency sigmoidectomy and sigmoidostomy were performed. Although re-operation was required twice, the patient could be saved and was discharged on postoperative day 52.
Assessing abdominal complications in patients with high spinal cord injury is very difficult, because the typical symptoms of acute abdomen cannot be detected in these patients. In cases of colonic perforation, a delayed diagnosis can result in fatal complications. The present case provides an example of a patient with spinal cord injury, and emphasizes the need for appropriate diagnosis and early treatment.
