SHM Converge Scientific Abstract ePoster Gallery-Silent but Dangerous: Recognizing Bowel-Related Autonomic Dysreflexia in Patients With Spinal Cord Injuries

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This case describes a 77-year-old man with a cervical spinal cord injury, quadriplegia, neurogenic bladder, and bowel dysfunction who presented with one week of episodic presyncope, often when sitting upright in his wheelchair. He had constipation, abdominal distension, and imaging showing diffuse ileus with colonic dilation up to 8.1 cm.<br /><br />During hospitalization, he demonstrated marked blood pressure instability: intermittent supine hypertension with systolic pressures up to 200 mm Hg and orthostatic hypotension with systolic pressures dropping to 90 mm Hg. He also reported similar episodes of blood pressure fluctuation and presyncopal symptoms during prior screening colonoscopies, likely related to scope passage and insufflation. His symptoms and blood pressure changes resolved after bowel movements, with no further major fluctuations.<br /><br />The report emphasizes autonomic dysreflexia, a potentially life-threatening condition seen in patients with spinal cord injuries above T6. It is triggered by noxious stimuli below the level of injury, most commonly bladder or bowel distension, and can cause sudden severe hypertension, headache, flushing, diaphoresis, and in severe cases stroke or seizure. Orthostatic hypotension may also coexist.<br /><br />The key clinical message is that bowel-related autonomic dysreflexia should be considered in spinal cord injury patients who present with severe hypertension, presyncope, or orthostatic hypotension, especially when constipation or bowel distension is present. Management should avoid large-volume enemas and vigorous manual rectal stimulation, as these may provoke dysreflexic episodes.

Asset Subtitle

Joseph Han

Meta Tag

Author List Cindy Fang, Joseph Han

Category Clinical Vignettes

Concept Autonomic Dysreflexia

Concept Spinal Cord Injury

Concept Hypertension

Concept Thoracic Spinal Cord Level T6

Concept Colonic Distention

Distinguished Non-Finalist

Presenter Organization NYU Langone

Presenting Author Joseph Han

Track Adult

Keywords

autonomic dysreflexia

spinal cord injury

quadriplegia

neurogenic bladder

bowel dysfunction

orthostatic hypotension

supine hypertension

constipation

colonic dilation

presyncope

Autonomic Dysreflexia

Spinal Cord Injury

Hypertension

Thoracic Spinal Cord Level T6

Colonic Distention