Disclosures: VAN T. NGUYEN, DO: No financial relationships or conflicts of interest

Case Diagnosis: Autonomic Dysreflexia in a 65 year old male with C6 AIS A quadriplegia, history of colonic volvulus status post sigmoidectomy with end colostomy and Hartmann’s pouch, and known chronic diversion colitis

Case Description: Patient presented with grey rectal discharge, episodic hypertension (up to 200 mmHg) associated with pounding headaches, sweating and worsening spasms suggestive of Autonomic Dysreflexia (AD). Computed tomography of abdomen/pelvis was suggestive of diversion colitis on the Hartmann’s pouch. The remainder of his work up was negative for possible other acute pathologies.

Setting: Tertiary care hospital, inpatient rehabilitation facility (IRF)Assessment/

Results: Routine colonoscopies had shown colitis in the patient’s Hartmann’s pouch, evidenced by erythema, small erosions with ulcers, and friability. Since he had no complaints, treatment was not indicated. Due to new symptoms of rectal discharge and AD, he was started on a routine of short chain fatty acid (SCFA) enemas twice daily. AD symptoms resolved 2 weeks after starting SCFA enemas. Repeat flexible sigmoidoscopy 6 weeks later demonstrated improved proctitis and resolved discharge.

Discussion: We describe a case with an uncommon trigger of AD. Although any stimuli below the level of injury could potentially cause AD, it is important to list diversion colitis on the differential with presence of colostomy. Prompt work up with a colonoscopy will facilitate accurate diagnosis, and therefore timely initiation of SCFA enema treatment.

Conclusion: Elective colostomies are an option for patients living with a spinal cord injury for management of neurogenic bowel, management of sacral wounds, and possibly resulting in improved quality of life. Routine colonoscopy is recommended post colostomy since diversion colitis is a common complication of end colostomies. Diversion colitis is a novel cause for AD.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/autonomic-dysreflexia-secondary-to-diversion-colitis-a-case-report/