INTRODUCTION: Vascular injuries during lumbar disc surgery vary between 1 and 5 per 10.000 disc operations and usually represent life- threatening events. MATERIAL AND METHODS: The authors present a case of aorto-iliac and ICV laceration during lumbar disc hernia repair, successfully treated with immediate damage control and direct suture, followed by endovascular procedure. CASE REPORT: A 34-year-old lady was operated on for a symptomatic disc herniation at L4-L5. Shortly after this pro- cedure, an ipovolemic shock (IV degree) suddenly occurred with an evident abdominal distension. An emergent laparo- tomy in the same neurosurgery OR was then performed and revealed an active haemorrhage arising from an expansive retroperitoneal bleeding at the level of aorto-iliac bifurcation. After a proximal and distal damage control (manual com- pression plus aortic clamping) aortic and caval lacerations were repaired. An abdominal packing completed the proce- dure, due to the concomitant coagulopathy applied. At the second surgical look, carried out 24 hours after the first pro- cedure, no active bleeding or vascular impairment were detected but an intraoperative US examination revealed a 3,5 cm wide right iliac pseudoaneurism confirmed by angioCT scan. This pseudoaneurism was later successfully treated with a double endovascular stenting. Postoperative outcome was uneventful and the patient was then discharged 11 days after the discectomy. Follow up study at 2 years did not demonstrate significant sequels. CONCLUSION: Although rare, vascular injuries during lumbar disc hernia surgery, are extremely severe complications, lea- ding to high morbidity and mortality rates. In case of massive bleeding the presence of an “intrahospital” trauma team is a crucial factor for life-saving.
Hemorrhagic shock caused by iatrogenic aorto-cava injury. Case report
SECCIA, MASSIMO
2007-01-01
Abstract
INTRODUCTION: Vascular injuries during lumbar disc surgery vary between 1 and 5 per 10.000 disc operations and usually represent life- threatening events. MATERIAL AND METHODS: The authors present a case of aorto-iliac and ICV laceration during lumbar disc hernia repair, successfully treated with immediate damage control and direct suture, followed by endovascular procedure. CASE REPORT: A 34-year-old lady was operated on for a symptomatic disc herniation at L4-L5. Shortly after this pro- cedure, an ipovolemic shock (IV degree) suddenly occurred with an evident abdominal distension. An emergent laparo- tomy in the same neurosurgery OR was then performed and revealed an active haemorrhage arising from an expansive retroperitoneal bleeding at the level of aorto-iliac bifurcation. After a proximal and distal damage control (manual com- pression plus aortic clamping) aortic and caval lacerations were repaired. An abdominal packing completed the proce- dure, due to the concomitant coagulopathy applied. At the second surgical look, carried out 24 hours after the first pro- cedure, no active bleeding or vascular impairment were detected but an intraoperative US examination revealed a 3,5 cm wide right iliac pseudoaneurism confirmed by angioCT scan. This pseudoaneurism was later successfully treated with a double endovascular stenting. Postoperative outcome was uneventful and the patient was then discharged 11 days after the discectomy. Follow up study at 2 years did not demonstrate significant sequels. CONCLUSION: Although rare, vascular injuries during lumbar disc hernia surgery, are extremely severe complications, lea- ding to high morbidity and mortality rates. In case of massive bleeding the presence of an “intrahospital” trauma team is a crucial factor for life-saving.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
