Gastrointestinal complications

Ileus, due to autonomic disruption, other intra-abdominal pathology, or retroperitoneal hematoma from vertebral fractures, is common in acute spinal cord injury. Nasogastric tubes should be placed and enteral feeding cautiously initiated, preferably beyond the ligament of Trietz.

Stress gastritis can occur and appropriate prophylaxis should be commenced. Coincidental intra-abdominal pathology is a diagnostic dilemma since symptoms are altered or absent because of paralysis. Some visceral sensation may be present as a result of vagal afferents, but any pain will be poorly localized and guarding will be absent. Any patient with pyrexia, leukocytosis, cardiovascular instability, nausea, and intolerance of enteral feeding should be investigated for intra-abdominal pathology, as morbidity and mortality are significantly increased if diagnosis is delayed.

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