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Kim J. Charney, MD; George L. Juler, MD; A. Estin Comarr, MD

Arch Surg. 1975;110(9):1083-1088.

Abstract
Twenty-four patients with spinal cord injuries were studied to correlate their responses to intra-abdominal disease with the level and completeness of the cord lesion. Patients with complete cervical lesions and lesions of the upper part of the thoracic region (C-4 to T-6) usually responded by early nonlocalized abdominal pain associated with signs of autonomic dysreflexia. As the disease progressed to involve the parietal peritoneum, these patients were more capable of localizing pain to the corresponding dermatome, whereas patients with incomplete lesions were able to localize their pain earlier. Patients with lumbar lesions and lesions of the lower part of the thoracic region (T-7 to L-3) were able to localize their pain earlier than those with lesions located higher in the thoracic region. All patients had delayed diagnoses except those with hemorrhage of the upper part of the gastrointestinal tract. Irrespective of level of cord lesion, increased pulse rate was the most prominent objective acute intra-abdominal pathologic finding. Shoulder pain in the quadriplegic is a most helpful sign.

Author Affiliations
From the Surgical and Spinal Cord Injury Service, Veterans Administration Hospital, Long Beach, Calif (Drs. Charney and Juler); the Department of Surgery, School of Medicine, University of California, Irvine (Dr. Juler); the Division of Surgery, School of Medicine, University of Southern California, Los Angeles (Dr. Comarr); and the Division of Urology, School of Medicine, Loma Linda (Calif) University (Dr. Comarr).

Footnotes
Accepted for publication Feb 11, 1975.

Read before the annual meeting of the Southern California Chapter of the American College of Surgeons, Santa Barbara, Calif, Jan 18, 1975.

Reprint requests to Veterans Administration Hospital, 5901 E Seventh St, Long Beach, CA 90801 (Dr. Juler).

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