200 Section - The Diagnostic and Therapeutic Dilemma of Suspected Rectal Perforation in a Patient with Neurogenic Bowel Dysfunction after Quadriplegia: A caes report

A 39-year-old male with C3 AIS C quadriplegia due to cervical spinal cord hyperextension injury, complicated by suspected rectal perforation, neurogenic bowel dysfunction, and functional constipation.

Case Description:

The patient was transferred to rehabilitation Unit on October 9, 2025, following cervical spine surgery. He develope persistent constipation despite laxative use. Abdominal CT revealed perianal gas and fluid, raising concern for rectal perforation, particularly given his history of perianal abscesses and fistulas.

This finding led to a critical dilemma: managing his neurogenic bowel while avoiding interventions (enemas, digital stimulation) that could exacerbate a potential perforation. A multidisciplinary team recommended conservative bowel management. The patient subsequently developed a febrile episode with elevated inflammatory markers.

Antibiotic therapy was effective. Rehabilitation was adapted to include abdominal massage, oral laxatives (Lactulose, Bisacodyl), and probiotics, avoiding rectal stimuli. Spontaneous bowel movement was eventually achieved on October 24.

Discussions:

This case highlights the significant rehabilitation challenge of managing neurogenic bowel dysfunction in the context of potential rectal injury. The primary dilemma involves balancing effective bowel evacuation to prevent complications like impaction or autonomic dysreflexia against the risk of causing or worsening a perforation with standard techniques. Non-invasive imaging (CT/MRI) is crucial for monitoring, while invasive diagnostic procedures (e.g., colonoscopy) carry high risks. Conservative strategies, including meticulous oral medication management, abdominal physiotherapy, and leveraging the gastrocolic reflex, become paramount. This scenario necessitates a highly individualized, cautious, and interdisciplinary approach to balance rehabilitation progress with patient safety.

Conclusions:

For spinal cord injury patients with suspected rectal perforation, rehabilitation must prioritize safety, favoring conservative bowel management over invasive techniques. A multidisciplinary approach is essential to navigate the of promoting bowel function while minimizing the risk of life-threatening complications. This case underscores the need for tailored protocols and heightened vigilance in managing neurogenic bowel when compounded by potential structural compromise.