Disclosures: Matthew C. Severson, MD: Nothing to disclose

Case Description: The patient became febrile and tachycardic without localizing signs or symptoms of infection or inflammation. Physical Medicine and Rehabilitation (PM&R) felt it unlikely that this was due to autonomic dysfunction. Fevers persisted despite broad spectrum intravenous (IV) antibiotics. A computed tomography (CT) scan of the chest, abdomen, and pelvis with IV contrast revealed rectal wall thickening and perirectal inflammation, consistent with proctitis. Internal medicine (IM) and infectious diseases (ID) were consulted. Neurogenic bowel management regimen included a docusate sodium/benzocaine enema and rectal digital stimulation. Upon transfer to an IM service for additional fever workup, this regimen was discontinued. A magnetic resonance imaging scan of his abdomen and pelvis confirmed the findings seen on CT.

Setting: Tertiary Care Inpatient Rehabilitation Facility and Acute Care Hospital

Patient: A 30-year-old man with complete paraplegia secondary to a nontraumatic thoracic spinal cord injury (SCI) undergoing acute inpatient rehabilitation

Assessment/Results: Since discontinuing digital stimulation, the patient has remained afebrile, and tachycardia has resolved. He resumed inpatient rehabilitation and is on a stable bowel regimen using daily docusate sodium/benzocaine enemas. Among PM&R, IM, and ID, the concern was that digital stimulation in this patient led to proctitis and a systemic inflammatory response.

Discussion: This is the first reported case, to our knowledge, of an association between rectal digital stimulation for routine bowel care and an inflammatory response in a patient with SCI. As it is uncommon for patients with SCI to have advanced pelvic imaging during rehabilitation, it is unknown if findings such as in this patient should be considered atypical.

Conclusion: Digital stimulation in SCI patients may induce clinically significant inflammatory changes in the rectum evident on advanced imaging, which may necessitate an alternate approach to bowel management. Investigation of unexplained fevers in patients with SCI may require rectal imaging.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/proctitis-in-a-30-year-old-man-with-complete-paraplegia-a-case-report/