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Affected person with Massive, Intermittent Waves of Peristalsis



Neurogenic Megacolon in Spinal Wire Harm
A 44-year-old man with a 20-year historical past of quadriplegia from a gunshot wound to the neck introduced to the emergency division with signs of a urinary tract an infection. His medical historical past included persistent megacolon and neurogenic bladder, and he had been admitted to the hospital many occasions for the administration of urinary tract infections and constipation. On bodily examination, his stomach was distended, tender, nontender, and tympanic to percussion, with regular bowel sounds. Extraordinarily massive, intermittent waves of peristalsis had been famous (see video), and the affected person reported delicate cramping and a bloating sensation in affiliation with this discovering. Computed tomography of the stomach revealed huge dilatation of the transverse (Panels A and B), descending, and sigmoid colon of as much as 18 cm. There was additionally a considerable fecal burden because of neurogenic dysfunction (Panels A and B, asterisks). Stool softeners and laxatives had been administered, and the affected person was informed to keep away from antimotility brokers. Megacolon is prevalent in sufferers with spinal wire accidents, particularly in older sufferers and in these with accidents which have been current for greater than 10 years. Problems of megacolon embrace stomach compartment syndrome, volvulus, and fecal impaction. Definitive therapy consists of colectomy, colostomy, or each. This affected person opted for conservative medical administration of his neurogenic megacolon in accordance along with his signs.

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