Iatrogenic Left Internal Iliac Artery Perforation During Lumbar Discectomy

Abstract

Iatrogenic intra-abdominal vascular injury can result from lumbar discectomy via the posterior approach. Although it is well known and documented in the literature, few anesthesiologists have personal experience with this life-threatening incident. Here, we report a patient who sustained perforation of the left internal iliac artery at the L(4-5) level during posterior lumbar discectomy. The patient experienced refractory hypotension with tachycardia at the end of surgery, even with prompt fluid resuscitation and medical treatment. Abdominal distension and tenderness of the left lower abdominal quadrant were also noted. Emergency laparotomy was performed by the consulting vascular surgeon and revealed perforation of the left internal iliac artery. The vascular injury was successfully repaired. It is important that, as anesthesiologists, we must be aware of this potentially fatal complication. Prompt diagnosis and immediate laparotomy to control hemorrhage can result in favorable outcomes.

Emergency Lumbar Disk Operation: How Safe Is it?

“…It has usually been described as occurring during regular elective surgery. 22,23 Therefore it is rather unlikely that the occurrence of this complication is primarily related to timing of the procedure in the present series.…”

Iatrogenic left common iliac artery and vein perforation during lumbar discectomy: A fatal case

“…Iatrogenic vascular injury during lumbar disc surgery is a rare but life-threatening complication [1,4]. Even though it may represents a potentially catastrophic event, the majority of surgeons who operate on patients with herniated lumbar disc disease do not expect perforation of the ventral disc space with consequential vascular injury [5][6][7].…”

“…Bleeding from a vascular injury tends to be limited to the retroperitoneal space rather than being shed partially to the operating space, which explains why bleeding in the surgical site is detected in less than 50% of the reported cases [11][12]. Delayed diagnosis or lack of awareness of potentially fatal vascular injuries are due to the absence of bleeding from the surgical site [4,9]. In our case, after a quite regular initial postoperative course, the first clinical manifestations started two hours later and despite the prompt diagnosis by CT and a rapid laparotomy intervention, this complication was fatal.…”

“…Because arterial bleeding from a major vessel without immediate treatment could lead to a 100% mortality rate, any delay in starting treatment or performing irrelevant or inferior diagnostic procedures may prevent effective resuscitation and definite surgical repair [4,6,14]. Bleeding from venous injuries during surgery can remain undetected and may even stop spontaneously.…”

Iatrogenic iliac arteriovenous fistula with aortic pseudoaneurysm formation post lumbar (L4-L5) laminectomy and pedicular screw fixation

“…Nowadays lumbar laminectomy is a common surgery in daily practice and a very safe procedure, but it can result in sudden life threatening though infrequent vascular complications with greater than 50% mortality [ 1 ]. Such events usually require immediate intervention, so it is essential that anesthesiologists and surgeons be aware of this potential complication, its manifestation and treatment.…”