Acute abdominal emergencies and spinal cord injury; our experiences: a retrospective clinical study.

STUDY DESIGN: Retrospective review of medical notes. OBJECTIVE: To describe clinical, laboratory and examination findings of acute abdominal emergencies (AAE) in Turkish patients with spinal cord injury (SCI) and to examine diagnosis and management of AAE in early stages. SETTING: Inpatient rehabilitation unit of tertiary research hospital. METHODS: The medical records of 237 SCI patients were reviewed. The SCI patients who were recruited in the study had been diagnosed with AAE and treated medically or surgically while they were inpatients at the rehabilitation clinic. RESULTS: Nine out of 237 SCI patients had been diagnosed with one of the AAE. Three patients were AIS A, three patients were AIS B and three patients were AIS C. The most common AAE was acute cholecystitis; three patients were diagnosed with this. The others were single cases of intra-abdominal hemorrhage, intra-abdominal abscess, tuba-ovarian abscess, subileus, Crohn's disease and cholangitis. Three of the patients were treated with surgery and six were treated medically. The most common symptoms in patients were fever, abdominal pain and abdominal discomfort (four of AAE). Three patients had abdominal tenderness and abdominal distension. The expected findings of AAE, rebound and defense, were positive only in two patients. CONCLUSION: Gall bladder disease is a common cause of AAE. The classic symptoms and examination findings will usually not facilitate acute abdomen diagnosis in the SCI group, so we should be aware of patients' subjective complaints and when necessary use advanced imaging techniques immediately.

Compliance with clean intermittent catheterization in spinal cord injury patients: a long-term follow-up study.

STUDY DESIGN: Retrospective review of medical notes. OBJECTIVE: To evaluate spinal cord injury (SCI) patients' compliance with bladder emptying method at long-term period after discharge and determine the frequency of urinary tract infections (UTIs). SETTING: Inpatient rehabilitation unit of tertiary research hospital. METHODS: Bladder management method of 164 new spinal cord injured patients were noted at discharge from rehabilitation center and follow-up. Patients were questioned whether they continued the initial bladder emtying method at follow-up, reasons for discontinuation and the history of treated UTIs. RESULTS: The most common bladder management method at discharge from inpatient rehabilitation center was clean intermittent catheterization (CIC) (63.4%). At follow-up 42% of the patients who used CIC changed their bladder emptying method. Rate of reverting to urethral indwelling catheter (IC) was 21.4%. Reasons for the patients who switched to IC application were recurrent UTIs, incontinence, nephrolithiasis, dependence on care givers and urethral strictures. For all patients, the frequency of treated UTI in 1 year was 38.8%. The number of UTIs were highest in patients using IC. CONCLUSION: Many factors, including urological complications, patient's preference, living environment, life-style and level of injury should be considered in deciding the method of bladder management in SCI patients. The CIC is a reliable and effective method in selected SCI patients. Despite changes in bladder emptying method, CIC was the most preferred method at long-term follow-up. Education of patients on catheterization technique and periodic follow-up is necessary to maintain patient compliance.