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[Left iliac artery injury during lumbar laminectomy: case report]
Wanderley Rodrigues Moreira1, Hélio Humberto Cançado Xavier
1Hospital Israel Pinheiro, Brazil.
Insights
Iliac artery injury during lumbar laminectomy is rare but serious. A case report details a delayed presentation of left iliac artery injury seven hours post-surgery, highlighting potential anesthetic considerations.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Anesthesiology
Context:
- Lumbar laminectomy carries risks, including rare but severe vascular injuries.
- Spinal anesthesia was used for a lumbar laminectomy in a young, healthy male patient.
- Delayed presentation of complications can occur even with seemingly uncomplicated procedures.
Purpose:
- To report a case of left iliac artery injury following lumbar laminectomy.
- To discuss the clinical presentation and management of this rare complication.
- To emphasize the importance of vigilance for delayed vascular injury, irrespective of anesthetic technique.
Summary:
- A 31-year-old male developed hypotension, tachycardia, and abdominal pain seven hours after lumbar laminectomy under spinal anesthesia.
- CT scan revealed a large retroperitoneal hematoma, and exploratory laparotomy confirmed a left iliac artery injury.
- The patient recovered fully after surgical repair.
Impact:
- This case underscores the potential for delayed vascular injury after laminectomy, even when not apparent intraoperatively.
- It suggests that careful patient monitoring in the postoperative period is crucial for early detection of such events.
- The findings may inform anesthetic and surgical protocols for laminectomy, particularly regarding patient positioning and monitoring strategies.
Background And Objectives:
Iliac artery injury during laminectomy is an uncommon, however very serious event. This report aimed at presenting a case of left iliac artery injury in patient submitted to lumbar laminectomy under spinal anesthesia, that was clinically manifested in the immediate postoperative period, seven hours after beginning of surgery.
Case Report:
Male patient, physical status ASA I, 31 years old, 68 kg, submitted to lumbar laminectomy in prone position under spinal anesthesia in L2-L3 interspace with 20 mg 0.5% hyperbaric bupivacaine and 25 microg fentanyl. Surgery went on normally and seven hours after its beginning, already in the postoperative period, patient presented arterial hypotension, tachycardia, agitation and diffuse abdominal pain. An abdominal CT-scan showed extensive retroperitoneal hematoma and exploratory laparotomy revealed left iliac artery injury. After laparotomy, patient recovered without intercurrences.
Conclusions:
General anesthesia is mandatory depending on patients positioning and physical status. This case calls the attention to the fact that regardless of the anesthetic technique, there might be no operative field bleeding in the presence of vascular injury because this bleeding may be late. In our case, clinical manifestation was seven hours after beginning of surgery, when the patient had already recovered from anesthesia. However, the event (arterial hypotension) could have happened in the intraoperative period.
