title: Gastric dysmotility after abdominal surgery in persons with cervical spinal cord injury: a case series.
abstract: BACKGROUND
  Spinal cord injury (SCI) has been found to affect the physiology of the gastrointestinal tract. Changes in gastric motility occur in tetraplegia because of dissociation of antral and duodenal motility. Among individuals with high-level tetraplegia, antral quiescence has been hypothesized as a manifestation of autonomic dysreflexia after surgery. This case series shows the issues with gastric hypomotility after gastrointestinal surgery in tetraplegic patients with tetraplegia, including management strategies.
  
  
  OBJECTIVE
  To report 3 patients with complete high cervical SCI who developed gastroparesis after abdominal surgery and discuss the effect of autonomic dysfunction on gastric motility.
  
  
  METHODS
  Retrospective chart review of 3 cases.
  
  
  RESULTS
  Gastroparesis occurred after abdominal surgery in 3 patients with C4 American Spinal Injury Association (ASIA) A tetraplegia and seemed to be a sign of autonomic hyperreflexia caused by postoperative pain. Management was challenging because it consisted of balancing of appropriate pain medication and dealing with absorption issues and dysmotility. Often gastric motility agents were not effective in improving gastric emptying. However, increased use of pain medication improved gastric emptying, which supports the hypothesis that this issue represents gastric dysfunction from autonomic hyperreflexia.
  
  
  CONCLUSIONS
  In persons with complete cervical SCI who have undergone abdominal surgery, postoperative gastroparesis can be a manifestation of pain. This may occur as the excessive sympathetic response from autonomic hyperreflexia inhibits distal antral activity. Thus, treatment of postoperative gastroparesis should focus on improved pain control to decrease excessive splanchnic sympathetic output and circulating norepinephrine.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 602A, Little Rock, AK 72205, USA. mspacheco@uams.edu
authors.forename: Marilyn S
authors.initials: MS
authors.lastname: Pacheco
authors.forename: Susan V
authors.initials: SV
authors.lastname: Garstang
mesh_terms: D000005:Abdomen / Q000473:pathology / Q000601:surgery*; D000328:Adult; D004065:Digestive System Abnormalities / Q000209:etiology* / Q000473:pathology; D016145:Endoscopy, Digestive System / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D013119:Spinal Cord Injuries / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods