====== I15193 ====== **Diagnosis**: [[Lumbar Canal Stenosis]] with severe [[paraparesis]] secondary to [[spondylodiscitis]]/[[epidural abscess]]. [[Laminectomy]] L3 performed at another center ---- **Clinical History**: - The patient had been evaluated multiple times at the Primary Care Center (CAP) for lumbar canal stenosis. - [[Arthrodesis]] L2-L5 was planned but has not been performed. - Severe paraparesis post-laminectomy L3. - Post-surgery complications include requiring home oxygen therapy and presenting with a urinary catheter with mild hematuria. - General condition is stable, but there is an active herpes labialis infection. --- **Current Clinical Course**: 1. **Gastrointestinal Evaluation**: - Assessed by Internal Medicine (MDI) for suspected paralytic ileus, likely secondary to lumbar pathology and/or opioid use. - **Plan**: CT abdomen to rule out obstructive cause. Offer of nasogastric tube insertion for discomfort/nausea, but patient opted to wait for urgent CT results. - Following CT, if negative for obstruction, initiate diet to stimulate peristalsis given patient's minimal intake since admission (absolute diet since 28-10). 2. **Physical Examination**: - Blood Pressure: 148/97 mmHg, Heart Rate: 68 bpm, Oxygen Saturation: 98% on room air. Afebrile. - Abdomen: Soft, non-tender, with reduced bowel sounds, no signs of peritonitis. Reports no recent passage of gas or stool. 3. **Laboratory and Imaging Results**: - **CT Abdomen and Pelvis (with contrast)**: Normal caliber of colon and small bowel, no signs of obstruction or mesenteric fat inflammation. Mild rectosigmoid wall edema without adjacent fat involvement. No free fluid, intra-abdominal collections, or pneumoperitoneum noted. Severe degenerative changes in the lumbar spine. - **Thoracic CT Findings**: Centrilobular branching opacities suggesting distal airway inflammation/infection. Rib fracture calluses on the lower right side. - **Laboratory Results**: Normal renal function and electrolytes, slight cholestasis, CRP < 3, hypoalbuminemia, and bicitopenia (leukopenia and anemia), with normal platelet count. --- **Management Plan**: - **Abdominal/Gastrointestinal**: With no evidence of intestinal obstruction, paralytic ileus, or Ogilvie syndrome, abdominal pathology is ruled out. Initiate diet to promote intestinal motility and assess bowel movements following dietary reintroduction. - **Internal Medicine Consultation**: MDI will continue monitoring; patient remains under combined care with Endocrinology for nutritional support and general management. - **Neurological Follow-up**: The patient remains pending lumbar puncture for further analysis related to suspected epidural abscess. --- The team remains available for further consultation and adjustments to the management plan.