The diagnosis of intra-abdominal injury in patients with cervical cord trauma

A review of the records of 288 patients sustaining blunt cervical column and/or cord injuries revealed that twelve (4.2%) had significant intraabdominal injuries, all occult, and all detected by peritoneal lavage. Three of 58 patients in shock (BP <100 mm Hg) with neurologic deficits were found to have intra-abdominal injuries. Shock in another 15 was the result of major associated injuries and/or the loss of sympathetic vascular tone. Thus 40 of these 58 patients (69%) had neurogenic shock. An analysis of the mechanisms of injury and associated injuries indicated that those at risk of having significant intra-abdominal injury are those who have been injured in a vehicular crash and those who have other obvious major injuries that can cause shock. The data indicate that patients not at risk of having intraabdominal injury can be selected for early attempts at anatomic cervical realignment in an effort to achieve return of neurologic function.