with cervical cord lesions have an elevated susceptibility of developing life-threatening gastrointestinal complications. and lower limbs. Deep tendon reflexes were sluggish in both upper and lower limbs. Bilateral planters were extensor. X-ray of the cervical spine was normal. Magnetic resonance imaging of the cervical spine showed diffuse cord compression (C3-5 level) with signal intensity changes [Figure 1]. Figure 1 Magnetic resonance imaging of the cervical spine T1W and T2W sagittal images showing C3-5 cord compression Blood investigations including hemoglobin total leukocyte and differential counts were within the normal limit except a raised erythrocyte sedimentation rate. Mantoux test was positive. The patient was managed conservatively and was on a low dose of steroids. On the third post-admission day the patient developed hypotension (blood pressure not really recordable pulse not really palpable) and got increased engine weakness. The individual became drowsy. Upper body OSU-03012 and comprehensive per-abdomen examinations had been normal. Clinically a chance of worsening in cervical wire edema with resultant vertebral surprise was suspected. Appropriately beneath the cover of proton pump inhibitors the dosage of steroid was escalated and the individual was resuscitated with intravenous liquids and held nil orally. The individual became alert as well as the pulse and blood circulation pressure became normal gradually. Nevertheless after 48 h he began developing stomach distension and respiratory distress. Per-abdominal examination revealed no guarding rigidity or rebound tenderness. Liver dullness was obliterated and bowel sounds were absent. Based on these findings a diagnosis of perforation peritonitis was suspected and a nasogastric tube was inserted. As the patient was quadriplegic and bedridden a supine X-ray chest and stomach could be performed and it was noncontributory; however an X-ray stomach in the lateral decubitus (after pushing 100 cc air flow through the nasogastric tube) showed free air flow in the peritoneal cavity and diagnosis of perforation of hollow viscous was made [Physique 2]. Previous history related to peptic ulcer disease was non-contributory. Repeat blood examination showed polymorphonuclear leucocytosis with a total count of 12 0 The patient underwent emergency laparotomy and repair of a pre-pyloric 0.5 cm × 0.5 cm anterior wall OSU-03012 peptic perforation. Physique 2 X-ray of the chest and upper stomach with both domes from the diaphragm showing up apparently normal. Nevertheless X-ray from the still left lateral decubitus demonstrated free of charge gas in the peritoneum (inset arrow) The utilization large-dose steroid administration continues to be advocated in spine-injured sufferers to reduce neurologic deficits; nonetheless it can become a two-edged sword[3 4 as there can be an upsurge in the occurrence of hemorrhaging and perforating gastrointestinal lesions in sufferers with cervical cable lesions [2 3 5 especially in TSPAN8 individuals with total deficits.[3] As in the present case patients with total high cervical cord lesions can develop painless perforation and peritonitis with an increase of morbidity.[2] As in today’s case in the backdrop of acute spinal-cord lesion clinical manifestations of silent life-threatening severe abdominal complication could be masked from the associated engine and sensory deficits. In today’s case it had been extremely hard to diagnose if the gastric perforation was due to the usage of steroids or was a unique problem of Cushing’s ulcer in an individual of spinal-cord lesion. As with the OSU-03012 books we recommend that a high index of suspicion and an aggressive therapeutic approach is necessary to avoid an increase in morbidity.[2 3 In summary when there is a hollow viscous perforation it is straightforward and quite easy to diagnose based on clinical and radiological findings. However when routine X-ray of the abdomen is inconclusive a lateral X-ray of the abdomen after insufflation OSU-03012 of the 100 cc atmosphere through the nasogastric pipe might help in the analysis without the additional want of computed tomography scan from the abdominal. Footnotes Way to obtain Support: Nil Turmoil appealing: None announced. Sources 1 Albert TJ Levine MJ Balderston RA Cotler JM. Gastrointestinal problems in spinal-cord.