Abdominal aortic injury during lumbar microdiscectomy

Vascular injuries during lumbar spine surgery are rare but potentially life-threatening, most commonly involving the iliac vessels and, less frequently, the abdominal aorta. Early recognition and prompt management are critical for patient survival. We report a case of a 48‑year‑old male who underwent L4-L5 microdiscectomy for severe lumbar disc herniation. During discectomy, the anterior disc annulus was inadvertently perforated, resulting in massive arterial bleeding and hemodynamic collapse. Emergency laparotomy revealed active bleeding from the posterolateral abdominal aorta just above the bifurcation. Hemostasis was achieved via packing and aortoiliac clamping, followed by implantation of a prosthetic aortoiliac graft with a proximal aorto‑prosthetic anastomosis. The patient was successfully resuscitated and transferred to the intensive care unit for monitoring. Iatrogenic abdominal aortic injury during lumbar discectomy, though rare, represents a surgical emergency. Rapid recognition, multidisciplinary management, and immediate surgical intervention are essential for survival. Open repair remains the gold standard in hemodynamically unstable patients, while endovascular approaches may be considered in stable cases.