Incidence and Risk Factors of Acute Pancreatitis After Scoliosis Surgery

Feng, Fan; Tan, Haining; Li, Xingye; Qiao, Ye; Chen, Chong; Lin, Youxi; Zheng, Lirong; Shen, Jianxiong

doi:10.1097/brs.0000000000002389

Cited by 13 publications

(21 citation statements)

References 22 publications

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Section: Discussionmentioning

confidence: 98%

“…Incidence varies among previous studies between 0.2 [ 10 ] and 7.4% [ 1 ]. Children with cerebral palsy undergoing spine surgery for scoliosis are the most likely to develop postoperative acute pancreatitis after posterior spinal fusion, with an incidence up to 30–55% [ 10 , 11 ]. Correlation with lower body mass index (BMI), severe bleeding, intraoperative hypotension, preoperative Cobb angle of the main curve, and correction rate has been reported [ 10 ].…”

Section: Discussionmentioning

confidence: 98%

“…Children with cerebral palsy undergoing spine surgery for scoliosis are the most likely to develop postoperative acute pancreatitis after posterior spinal fusion, with an incidence up to 30–55% [ 10 , 11 ]. Correlation with lower body mass index (BMI), severe bleeding, intraoperative hypotension, preoperative Cobb angle of the main curve, and correction rate has been reported [ 10 ]. In contrast with other literature, Laplaza et al found only older age and lower body index mass to be related to postoperative pancreatitis in 80 adolescents undergoing surgery for idiopathic scoliosis, thus excluding intraoperative bleeding and hypotension among risk factors [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

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Acute pancreatitis after major spine surgery: a case report and literature review

et al. 2018

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BackgroundAcute pancreatitis has been described as potential complication of both abdominal and non-abdominal surgeries. The pathogenetic mechanism underlying acute pancreatitis in spine surgery may include intraoperative hemodynamic instability causing prolonged splanchnic hypoperfusion, as well as mechanical compression of the pancreas due to scoliosis correction, with a higher risk in cases of more extended fusions, especially in young adults with lower body mass index (BMI).Case presentationWe report here a case of postoperative acute pancreatitis with benign evolution in a young female patient after the first and second surgery of a two-stage correction of right thoracic idiopathic scoliosis.In December 2017, the patient underwent first-stage T4-L3 posterior arthrodesis with T7-T12 osteotomies and temporary magnetic bar. Intraoperative blood loss required massive transfusion. In the immediate postoperative period, the patient started reporting nausea/vomiting, abdominal pain at pressure, moderate meteorism, abdominal distension, hypoactive bowel sounds, and fever. Laboratory tests indicated a progressive increase in aspartate aminotransferase, alanine aminotransferase, serum amylase, lipase, phospho-creatine kinase, and reactive C-protein. A CT scan showed free abundant abdominal fluid in the hepatic, renal, pancreatic, and pelvic regions. After the diagnosis, a hypolipidic diet was initiated, and good hydration per os was maintained. After gastroenterologic consultation, somatostatin, rifaximin, and ursodehoxycholic acid were initiated and maintained for 8 days. In the following days, laboratory tests showed a slow but consistent decrease in liver and pancreatic enzymes until normalization. In January 2018, the patient underwent second-stage surgery with removal of magnetic bar, definitive posterior fusion, and instrumentation T4-L3. Laboratory tests showed a second, even more significant, increase in the amylase and lipase level and a moderate increase in the reactive C-protein. Therapy was maintained until complete normalization of amylase and lipase levels.ConclusionsEarly recognition of symptoms plays a key role in preventing severe morbidity after scoliosis surgery. When symptoms suggest abdominal complication, pancreatic and liver enzymes are to be evaluated for posing prompt diagnosis. Gastroenterologic consultation and eventual imaging are further steps in differential diagnosis and treatment of this rare complication.Electronic supplementary materialThe online version of this article (10.1186/s13013-018-0170-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Acute pancreatitis after major spine surgery: a case report and literature review

et al. 2018

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“…Acute pancreatitis following spine surgery has been reported as a rare complication with a low incidence (7.4%). 6 Although the exact mechanism is still unclear there are well recognized risk factors such as direct trauma to pancreas from pedicle screws, use of high speed drilling, re-alignment of the spine, mechanical compression of pancreas due to prone position, low BMI, intraoperative hypotension, decreased splanchnic circulation, massive haemorrhage and long segment of fusion. 6,7,8 According to the Atlanta criteria, 9,10 to diagnose acute pancreatitis it requires two of the following three criteria: (a) abdominal pain strongly suggestive of acute pancreatitis, (b) serum amylase and/or lipase level at least 3 times higher than the upper limit of normal level or (c) hallmark imaging findings.…”

Section: Discussionmentioning

confidence: 99%

“…The degree of correction or long segment fusion might be an independent risk factor for development of acute pancreatitis. 6…”

Section: Discussionmentioning

confidence: 99%

A rare case of pancreatitis following scoliosis correction

Hewavitharane

Jayathilaka

2020

Sri Lankan J Anaesthesiol

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Acute pancreatitis following major spinal surgery is a rare potential complication. Several mechanisms such as positioning, intraoperative haemodynamic instability, mechanical compression and prolonged surgery can contribute to it. This should be suspected in a patient presenting with gastrointestinal symptoms, signs and raised serum amylase or lipase. Our case report is of a young patient with low BMI developing postoperative acute pancreatitis after single stage correction of right thoracic idiopathic scoliosis at National Hospital of Sri Lanka. Early identification of complications plays a key role in preventing severe morbidity after scoliosis surgery. When symptoms and signs are suggestive of abdominal complications, biochemical markers have to be analyzed for prompt diagnosis. Multidisciplinary approach and imaging are further steps in the differential diagnosis and management of this rare complication.

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