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[Massive haemorrhage after dorsal decompressive laminectomy]
1Département d'anesthésie-réanimation, CHU Charles-Nicolle, rue de Germont, 76031 Rouen, France. Luc-Marie.Joly@chu.rouen.fr
Annales Francaises D'Anesthesie Et De Reanimation
|July 12, 2005
Summary
A massive hemorrhage after spinal decompression surgery was initially treated for disseminated intravascular coagulation (DIC) without success. Aprotinine effectively stopped bleeding, revealing a prostatic metastasis as the cause.
Area of Science:
- Neurosurgery
- Hematology
- Oncology
Background:
- Massive hemorrhage can complicate dorsal decompressive laminectomy.
- Disseminated intravascular coagulation (DIC) is a potential complication following spinal surgery.
Observation:
- A patient developed massive bleeding post-laminectomy, initially presenting as DIC.
- Standard DIC treatment with plasma and platelets was ineffective.
- The patient required multiple reoperations due to rapidly progressing paraplegia.
Findings:
- Secondary fibrinolysis complicated the initial DIC.
- Aprotinine administration successfully controlled the hemorrhage.
- The underlying cause was identified as a vertebral metastasis of prostatic origin.
Implications:
- This case highlights the importance of considering secondary fibrinolysis in refractory bleeding post-laminectomy.
- Aprotinine may be a viable treatment option for intractable hemorrhage in this context.
- Prostatic cancer metastasis should be considered in the differential diagnosis of vertebral lesions causing spinal cord compression and hemorrhage.