Increased susceptibility of patients with cervical cord lesions to peptic gastrointestinal complications

Abstract

The incidence and risk factors in the development of hemorrhaging and perforating gastrointestinal (GI) lesions in 408 patients with cervical column/cord injury were studied retrospectively. Most injuries were caused by blunt trauma (94.1%). Male patients predominated (83.6%); the mean patient age was 35.8 years. Of the 408 patients, 190 (46.6%) had complete cord deficits, 111 (27.2%) had incomplete deficits, and 107 (26.2%) were intact. Admission shock (systolic BP less than 100 mm Hg) was present in 31.6% and 20.7% of patients with complete and incomplete lesions, respectively, and in 4.7% of those intact. Patients with complete deficits received corticosteroids for 2 days; patients with incomplete deficits received them for 7 to 10 days. Eleven of the 107 intact patients (10.3%) received steroids. All patients received standard antacid therapy. Nine patients without previous GI disease developed peptic ulcerations: six gastric and three duodenal lesions (six were perforated) that required surgical intervention; all occurred in patients with complete deficits. Both the 4.7% incidence of the lesions in those patients compared with the other victims of cervical trauma and an estimated 0.1% incidence among more than 6,000 other seriously injured patients are significant (p less than 0.005, p less than 0.001). Steroids were not an ulcerogenic factor.