Crohn's disease in a patient with acute spinal cord injury

[Wise Young]

• Yung JC and Groah SL (2001). Crohn's disease in a patient with acute spinal cord injury: A case report of diagnostic challenges in the rehabilitation setting. Arch Phys Med Rehabil. 82 (9): 1274-8. Summary: Yung JC, Groah SL. Crohn's disease in a patient with acute spinal cord injury: a case report of diagnostic challenges in the rehabilitation setting. Arch Phys Med Rehabil 2001;82:1274-8. Diagnosis of the abdominal emergency in tetraplegic and high paraplegic patients remains challenging. Classic peritoneal signs, such as a rigid abdomen, rebounding, guarding, and Murphy's sign may be absent, whereas subtle physical, laboratory, or radiologic abnormalities may be the only evidence for an acute abdomen. Our report describes the course of a 70- year-old man with C5 American Spinal Injury Association class A tetraplegia who developed a perforated cecum secondary to Crohn's disease. We review the visceral and somatic sensory pathways for abdominal pain with emphasis on the challenges in assessing the acute abdomen in a patient with spinal cord injury (SCI). Recommendations for the assessment of the acute abdomen in an individual with SCI will be provided. This is the first reported case of Crohn's disease in an individual with an acute SCI. It shows the importance of maintaining high clinical suspicion for unexpected intraabdominal processes that may lead to significant morbidity and mortality if left undiagnosed. Copyright 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11552203
http://www.mosby.com/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=abs&id=aapmr0821274&target=> Department of Functional Restoration, Stanford University, Palo Alto, CA (Yung); and the Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA (Groah).