The gastric emptying scan as a tool for surgical management of severe bowel dysfunction in spinal cord injury: 2 case reports.
We describe 2 patients with spinal cord injury (SCI) for whom the gastric emptying scan (GES) was crucial for determining the correct surgical approach in the therapeutic management of gastrointestinal complaints. Two men, ages 45 and 51 years, were admitted to a university hospital for delayed gastric complications from SCI. Both SCIs were traumatic, and the interval since injury was 18 months for the younger man and 6 months for the older man. Both men lacked voluntary motor and sensory function below the cord level of the lesion and had quadriplegia. Using GES, we measured motility (the cutoff for normal in this laboratory is 37%) and the time at which half the gastric contents were emptied (normal values are 45 +/- 8 min). Both patients had abnormal motility: residuals at 1 hour were above 50%. Half the gastric contents were emptied at 75 and 90 minutes, respectively. The therapeutic value of the GES was demonstrated for both patients, in combination with the history, physical examination, and abdominal radiographic studies. The first patient underwent ileostomy, and the second required a gastrostomy tube and a jejunostomy tube in addition to metoclopramide. The GES is a valuable diagnostic tool with an important role in the surgical management of patients with SCI.
Mukand
J A
JA
Southern NE Rehabilitation Center, Providence, RI 02907, USA.
Kaplan
M S
MS
Blackinton
D D
DD
Biener-Bergman
S
S
Trojan
D A
DA
D000932:Antiemetics / Q000627:therapeutic use; D003248:Constipation / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D005746:Gastric Emptying; D005769:Gastrointestinal Motility; D005774:Gastrostomy; D006801:Humans; D007081:Ileostomy; D007582:Jejunostomy; D008297:Male; D008787:Metoclopramide / Q000627:therapeutic use; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology; D011237:Predictive Value of Tests; D011782:Quadriplegia / Q000209:etiology / Q000503:physiopathology; D011859:Radiography; D011877:Radionuclide Imaging; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology; D013270:Stomach / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016896:Treatment Outcome
D000932:Antiemetics; D008787:Metoclopramide