Introduction
Ischemic colitis is uncommon in the general papulation. Hypoperfusion of the colon contributes to the pathogenesis of ischemic colitis. The risk factor of ischemic colitis is known 65 years and older, irritable bowel syndrome and chronic obstructive pulmonary disease. But in a patient of the spinal cord injury(SCI), ischemic colitis is not much known.
The aim of this study is to report a case of diagnosed with ischemic colitis in SCI and illustrates management and outcomes.
Case
A 48 years old previously healthy man got a traffic accident. After a few hours later, he got a lower extremities weakness and numbness sensation. He presented with a zero grade lower extremity weakness, loss of sensory up to the level C5. But voluntary anal contracture and deep anal sensation were preserved. He was prescribed high dose steroid therapy.
Magnetic resonance imaging (MRI) demonstrated high signal intensity in C2-4 level of spinal cord and low signal intensity hemorrhage in C3-4 disc level on T2 weighted images. He was diagnosed the spondylotic myelopathy due to ossification of posterior longitudinal ligament, C3-4. He underwent an anterior cervical discectomy with fusion. He was transferred to a rehabilitation medicine.
He had daily defecation but need clean intermittent catheterization. He took medicine of gastrointestinal regulator and laxative for bowel management. Three weeks later, he complained of pain in the suprapubic area. Despite urination with a nelaton, the pain persisted. Rather, pain developed at the RLQ area of the abdomen. On abdomen X-ray, the ileus was observed. The pain was exacerbated, abdominal computed tomography(CT) was taken. There was fecal stasis with small and large bowel dilatation.
Glycerin enema was performed and a small amount of fresh blood was mixed in the stool. Next day, he underwent sigmoidoscopic exam from an anal verge(AV) to AV 70cm. The mucosa of the colon was relatively normal below AV 7cm. However, severe mucosal edema, erythema and ulcer were continuously observed in AV 70cm ~ AV 7cm. No endoscopic findings were found other than atrophic gastritis. He took a supportive care including bowel rest and antibiotics.
After 4 days, the diet was tried, but the hematochezia recurred and high-spike fever occurred. Then, NPO was maintained. After two weeks, there was still linear or geographic ulceration in the follow-up sigmoidoscopy, but some improvement was seen. Three days later, the diet proceeded without hematochezia and fever.
Conclusion
The upper motor neurogenic bowel of SCI tends to have slower transit time throughout the colon and could result in severe constipation. Decreased sensation below the injury level aggravates this tendency. It makes the patient with SCI more susceptible to ischemic colitis than the general population. And they have a higher severity of ischemic colitis. Careful attention to the neurogenic bowel and management of fecal incontinence are required. |
