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Acute lower gastrointestinal bleeding as a late complication of spinal instrumentation
A M Al-Binali1, D Sigalet, S Goldstein
1Division of Gastroenterology/Nutrition, Department of Pediatrics, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada.
Insights
Spinal instrumentation for scoliosis can lead to rare complications. A child experienced severe gastrointestinal bleeding years after surgery due to internal iliac artery injury and bowel perforation.
Area of Science:
- Orthopedic Surgery
- Vascular Surgery
- Pediatric Gastroenterology
Background:
- Posterior or anterior spinal fusion with instrumentation is a standard surgical procedure for scoliosis correction.
- While common complications include blood loss and infection, vascular injury is less frequent.
- Acute gastrointestinal bleeding is an unreported complication following spinal instrumentation.
Observation:
- A pediatric patient presented with massive acute lower gastrointestinal bleeding six years post-posterior spinal instrumentation.
- The bleeding was attributed to an internal iliac artery injury.
- The injury also resulted in bowel perforation.
Findings:
- This case highlights a rare but severe delayed complication of spinal instrumentation.
- Internal iliac artery injury leading to gastrointestinal bleeding is a previously unreported sequela.
- The etiology, diagnosis, and management of this specific type of bleeding require careful consideration.
Implications:
- This finding expands the spectrum of known complications associated with spinal instrumentation for scoliosis.
- Early recognition and prompt management are crucial for patients presenting with delayed gastrointestinal bleeding post-surgery.
- Further research may be warranted to understand the mechanisms and preventative strategies for such vascular complications.
Abstract:
Posterior or anterior fusion with spinal instrumentation is a well-known operation for scoliosis. There are multiple potential complications; the most common are blood loss during the initial surgery and wound infection. Vascular injury has been reported. However, to the authors' knowledge, acute gastrointestinal bleeding has not been reported. The authors report on a child who presented 6 years after posterior spinal instrumentation with massive acute lower gastrointestinal bleeding resulting from internal iliac artery injury and bowel perforation. The etiology, diagnosis, and management of such bleeding is reviewed.