Development of hydronephrosis secondary to poorly managed neurogenic bowel requiring surgical disimpaction in a patient with spinal cord injury: A case report

Abstract

Context

Case of an adult patient with paraplegia managing neurogenic bladder with intermittent catheterization who was not performing a standard bowel program for management of neurogenic bowel.

Findings

Patient presented with increasing spasticity, fecal incontinence, and abdominal pain and ultimately was hospitalized for management. Imaging revealed massive fecal impaction, resulting in ureteral obstruction and hydronephrosis. Despite repeated aggressive bowel regimens, serial abdominal X-rays showed continued large stool burden. Ultimately surgical intervention was required to evacuate the colon and subsequently the hydronephrosis resolved.

Conclusion/Clinical relevance

This case illustrates the importance of proper management of neurogenic bowel, as significant medical complications, such as hydronephrosis can occur with poorly managed neurogenic bowel.

Keywords:

• Spinal cord injury
• Hydronephrosis
• Neurogenic bowel
• Surgical disimpaction

Acknowledgment

We would like to acknowledge Michael Y Lee, MD (Chair, Department of Physical Medicine and Rehabilitation, The University of North Carolina at Chapel Hill) for his support of this project.