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Neurological Rehabilitation

Atypical Presentation of Appendicitis in Spinal Cord Injury: A Case Report About Diagnostic Challenges and the Importance of Early Imaging

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Case Report Theater

    Primary Author(s)

  • RH

    Ryan Hubbell, Other

    Medical Student
    Medical College of Wisconsin
    Milwaukee, Wisconsin

    • Poster Presenter(s)

  • Frederick T. Halfman, MD (he/him/his)

    Resident Physician
    Medical College of Wisconsin Affiliated Hospitals PM&R Program
    New Berlin, Wisconsin

    • Co-Author(s)

  • CB

    Charlotte Ball, MD

    Assistant Professor
    Medical College of Wisconsin Affiliated Hospitals PM&R Program
    Milwaukee, Wisconsin

Disclosure(s):
Frederick T. Halfman, MD: No financial relationships to disclose
Case Diagnosis: Acute appendicitis with impending rupture in a patient with T5 AIS B incomplete paraplegia, initially complicated by concurrent urinary tract infection.

Case Description or Program Description: A 24-year-old male with T5 AIS B incomplete paraplegia presented with nonspecific abdominal pain, nausea, and fever during inpatient rehabilitation. Initial workup identified a urinary tract infection, delaying further investigation. However, abdominal pain and nausea persisted which prompted further workup. Abdominal imaging revealed acute appendicitis with signs of impending rupture. The patient underwent a laparoscopic appendectomy and recovered without complications.

Setting: Acute inpatient rehabilitation unit.

Assessment/Results: The patient developed acute epigastric pain with two episodes of non-bloody emesis four weeks into acute inpatient rehabilitation. Initial exam revealed mild tachycardia and epigastric tenderness. Broad laboratory workup showed leukocytosis with otherwise unremarkable findings. He later developed fever, tachycardia, and dysuria, with urinalysis confirming an e. Coli UTI. He was treated with ceftriaxone, but persistent symptoms and low-grade fevers raised concern. Abdominal CT scan ultimately revealed acute appendicitis with impending rupture, prompting urgent surgical intervention.

Discussion (relevance): This case highlights the diagnostic challenge of an otherwise classically-presenting pathology in patients with spinal cord injury as sensory changes and autonomic dysfunction below the level of the injury may obscure the hallmark symptoms. This specific case was complicated by nonspecific symptoms resembling various other acute abdominal pathologies in addition to concurrent UTI which further clouded the clinical picture. Delays in diagnosis due to atypical presentation leave this group at risk of developing more complications.

Conclusions: This case highlights the importance of maintaining a high index of suspicion and low threshold for early imaging in order to reduce the risk of complications from missed diagnoses in patients with SCI. Future research should focus on identifying consistent symptom patterns and the creation of concrete, standardized triage protocols to reduce time to diagnosis.