1229 - Leukocytosis in a SCI patient with a significant stool burden: A case report

Case Diagnosis: Cauda Equina with LMN neurogenic bowel.

Case Description: A 36-year-old female was admitted to UNC Medical Center with cauda equina syndrome and had surgical intervention resulting in neurogenic bowel and bladder. She managed neurogenic bladder with cathing every 4 hours. Her neurogenic bowel was difficult to manage, and she developed leukocytosis to 25.5 with a negative infectious workup. CT abdomen pelvis was obtained which demonstrated a large colonic/rectal stool burden and evidence of inflammation concerning for proctitis or transient intussusception. She required an aggressive bowel regimen and as she had bowel movements her leukocytosis started to improve until the patient left against medical advice.

Discussions: Cauda equina syndrome can lead to the development of neurogenic bladder and bowel. Neurogenic bowel secondary to cauda equina syndrome is often a lower motor neuron pattern and may need fecal disimpaction a management. Leukocytosis can develop secondarily to fecal impaction even prior to more severe conditions such as proctitis or stercoral colitis. In the case of our patient, her KUB on admission revealed moderate stool burden and she did not have significant bowel output with subsequent bowel cleanouts. Her severely elevated WBC, along with SCI-related stool burden, was the main driver behind more imaging, which showed her stool burden to be the source of her leukocytosis. Limitations include no imaging following WBC downtrend with increased stool output and discharge of the patient AMA before acute rehabilitation.

Conclusions: KUB is often the initial imaging modality used to assess stool burden. Despite an initial impression of moderate stool burden, consider that a significant stool burden and a concern for proctitis/stercoral colitis may be present in the setting of increasing leukocytosis in neurogenic bowel with negative infectious workup. Early abdominal CT may indicate such circumstances.