Paraplegia After Laparotomy for Large Bowel Obstruction: A Case Report.

Area of Science:

• Neurosurgery
• Vascular Surgery
• Anesthesiology

Background:

• Persistent postoperative paraplegia is a rare but devastating complication.
• Abdominal aortic aneurysms and bowel obstructions present complex surgical challenges.
• Cachectic patients with abdominal aortic aneurysms are at increased risk for surgical complications.

Purpose of the Study:

• To report a case of persistent postoperative paraplegia following emergent exploratory laparotomy.
• To investigate the potential causes of spinal cord ischemia in a cachectic patient with an abdominal aortic aneurysm.
• To emphasize the importance of intraoperative management in preventing neurological deficits.

Main Methods:

• Case report of a patient undergoing emergent exploratory laparotomy for large bowel obstruction.
• Review of intraoperative events, including hemodynamic stability and aortic manipulation.
• Postoperative magnetic resonance imaging (MRI) of the cervical, thoracic, and lumbar spine.

Main Results:

• The patient developed persistent paraplegia upon recovery from anesthesia.
• Spinal MRI revealed cervical spinal stenosis but no other spinal cord abnormalities.
• Hypothesized intraoperative factors include embolization from aortic manipulation and transient hypotension.

Conclusions:

• Intraoperative spinal cord ischemia can result from aortic manipulation and hypotension in high-risk patients.
• Maintaining hemodynamic stability and careful aortic handling are crucial during surgery for abdominal aortic aneurysms.
• This case underscores the need for vigilance in underweight patients with abdominal aortic aneurysms undergoing major surgery.