Acute abdominal emergencies in paraplegics

Abstract

D URING the past five !.enrs medical literature has stressed, time and time again, the fnct that the post\v:lr >‘e:lrs woulcl bring diagnostic problems to the cixsilian physician which he had not pre\,iousl>. encountered.‘,” The profession at large has been cautioned, e\~en in apparentI> simple diagnostic problems, to bear in mind the possibility of recurrent mnlnria and \.arious other exotic diseases \\.hen dealing \vith returned o\‘erseas x.eterans. I II addition to the tropical diseases to Mhich the returned militar> may be heir, there are other formerly rare maladies \\-hich the war has made common place. It \V:S estimated that at the close of hostilities there hvere approximately 2,000 paraplegic patients in army, na\ry and veteran administration hospitals.” Because of the progress made during the war years in the management of these patients, the maiority will be rehabilitated to the point of assuming n happy and useful life in the l.i\-il community. As this group of paraplegics returns to civil life the!, will bring to the ci\,ilinn physician rnan~’ diagnostic and therapeutic challenges. One of the most ditfrcult problems which the paraplegic patient presents is that of’ the acute tlbdominaI emergency. EeC’;IUS~ of the extreme debilitated state of such patients when returned from overseas areas of combat, because of the foci of infection in the decubitus ulcers and genitourinary tract, because of the tendency ot these patients to genitourinary caIcuIus formation and because of their low resistance to intercurrent disease, acute abdominal emergencies \vere seen far more frequentI)in a group of patients in :I p;lr:\plegic center than in an cc~ual number of healthy young adults. It is belie\,& that these patients after leaving these centers hvill continue to present perplexing sJ.ndromes of abdominal distress to the civil ph>.sician. The presence of :I profound neurologic lesion, which usu:~ll~~ results in :lnesthesia below the le\,el of iniur!-, makes the e\.aluation of these episodes an extremeI\. diffcult matter. The purpose of this paper is to enumerate certain factors which may be of assistance in e\.alunting symptoms of :it~dominal clistress in the paraplegic patient.