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 intra-abdominal injuries, all occult, and all detected by peritoneal lavage. Three of 58 patients in shock (BP less than 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 intra-abdominal injury can be selected for early attempts at anatomic cervical realignment in an effort to achieve return of neurologic function.