Dalton R. Rollison, DO
Resident, PGY 3
University of Louisville School of Medicine
Louisville, Kentucky, United States
Camilo Castillo, MD
Physician
University of Louisville School of Medicine
Louisville, Kentucky, United States
A 22-year-old male with complete motor tetraplegia transferred to Frazier Rehabilitation for SCI rehabilitation, ventilator weaning, tracheostomy management, and nutritional needs through a PEG placed in an outside hospital. Several weeks after admission, the patient's condition started deteriorating, including bouts of AD, shoulder pain, nausea, vomiting, and no abdominal distension or pain, along with decreased bowel sounds. An abdominal CT scan revealed a PEG tube placed incorrectly outside the stomach, partially piercing the left hepatic lobe, and the presence of free air in the upper anterior abdomen. The patient met the criteria for Sepsis and underwent emergent exploratory laparotomy to remove a dislodged gastrostomy tube, repair the gastrostomy using a modified Graham patch technique and also remove a hematoma from the gastric wall. Open Stamm gastrostomy tube was placed. The patient was then transferred back to Frazier Rehabilitation to continue rehabilitation to improve their functional independence.
Discussions: Motor-complete SCI may experience a disruption in their sensory input, which can impact their perception of pain. Therefore, it can be challenging to detect intra-abdominal issues in SCI patients due to the absence of symptoms during evaluation, which can put them at risk of developing an acute abdomen, sepsis, and other adverse outcomes, including death.
Conclusions:
Given the scenario in this case, after ruling out common causes of AD, as well as less common causes of AD, healthcare providers caring for SCI patients should maintain high awareness and suspicion for uncommon causes to prevent adverse outcomes. In this patient specifically there was no clear cause of the functional decline, therefore having a working relationship with the therapists, listening to patients, and keeping a low threshold for a more extensive workup can prove to be vital in patient safety and improvement.
