Perforated ileus after L5-S1 anterior lumbar interbody fusion: a case report presentation

Mahoney, Jennifer A.; Barnes, David S.; Pahl, Douglas W.

doi:10.21037/acr.2019.07.06

Cited by 4 publications

(3 citation statements)

References 13 publications

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“…Rates of postoperative ileus in ALIF patients vary in the literature, with between 2 and 58% reported [60], most commonly occurring between 2 and 5.4% [43], and occurring in both transperitoneal and retroperitoneal approaches [68]. Open ALIF approaches in this review had higher rates of postoperative ileus reported compared to laparoscopic procedures, with no significant difference between transperitoneal and retroperitoneal approaches (3.54% vs. 2.60%; p > 0.05).…”

Section: Postoperative Ileusmentioning

confidence: 65%

Is there a variance in complication types associated with ALIF approaches? A systematic review

Feeley

Clesham

et al. 2021

Acta Neurochir

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Purpose Anterior lumbar interbody fusion (ALIF) is a well-established alternative to posterior-based interbody fusion techniques, with approach variations, such as retroperitoneal, transperitoneal, open, and laparoscopic well described. Variable rates of complications for each approach have been enumerated in the literature. The purpose of this study was to elucidate the comparative rates of complications across approach type. Methods A systematic review of search databases PubMed, Google Scholar, and OVID Medline was made to identify studies related to complication-associated ALIF. PRISMA guidelines were utilised for this review. Meta-analysis was used to compare intraoperative and postoperative complications with ALIF for each approach. Results A total of 4575 studies were identified, with 5728 patients across 31 studies included for review following application of inclusion and exclusion criteria. Meta-analysis demonstrated the transperitoneal approach resulted in higher rates of retrograde ejaculation (RE) (p < 0.001; CI = 0.05–0.21) and overall rates of complications (p = 0.05; CI = 0.00–0.23). Rates of RE were higher at the L5/S1 intervertebral level. Rates of vessel injury were not significantly higher in either approach method (p = 0.89; CI = − 0.04–0.07). Rates of visceral injury did not appear to be related to approach method. Laparoscopic approaches resulted in shorter inpatient stays (p = 0.01). Conclusion Despite the transperitoneal approach being comparatively underpowered, its use appears to result in a significantly higher rate of intraoperative and postoperative complications, although confounders including use of bone morphogenetic protein (BMP) and spinal level should be considered. Laparoscopic approaches resulted in shorter hospital stays; however, its steep learning curve and longer operative time have deterred surgeons from its widespread adaptation.

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Section: Postoperative Ileusmentioning

confidence: 65%

Is there a variance in complication types associated with ALIF approaches? A systematic review

Feeley

Clesham

et al. 2021

Acta Neurochir

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“…In this case, the sigma lesion was not noticed and repaired during the ALIF surgery, and that was the trigger for the peritonitis and septic shock that occurred later. Mahoney, et al [13] described a case of a 72-yearold male who, 5 days after an ALIF surgery, developed an acute colonic pseudo-obstruction which later led to a colonic perforation that had to be surgically repaired. In this case however, the colonic injury did not take place during the surgery.…”

Section: Case Reportmentioning

confidence: 99%

Sigma Perforation and Septic Peritonitis after an Anterior Lumbar: A Case Report and Literature Review

Ricou¹,

Fa²,

Maldonado³

et al. 2022

Neurosurg Cases Rev

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Background: Anterior lumbar interbody fusion (ALIF) has become widely accepted for the treatment of discogenic low back pain, achieving similar radiological and clinical treatments to other techniques. To describe sigma perforation and septic peritonitis as a potentially fatal complication after an anterior interbody fusion.Case report: A 63-year-old women consulted to the emergency room for diffuse abdominal pain and nausea after a L5-S1 ALIF 5 days prior. Blood tests and X-Rays showed no alterations. A CT scan showed intraabdominal liquid and a pneumoperitoneum, later evolving to septic shock. An emergent laparotomy was performed to repair a 1 cm-long perforation of the minor sigma. One year later, patient was with no pain neither X-ray alteration. Conclusion:Potential complications of an anterior lumbar approach include iliac vein injury, thrombosis, or retrograde ejaculation. However, bowel injuries are uncommon, and a case of septic peritonitis after a sigma perforation, with high morbidity, has never been described before.

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“…15 Other ALIF complications that have been described include ureter injury, neurological injury, postoperative ileus, colonic pseudoobstruction, superficial infection, urinary tract infection, sepsis, subsidence, pseudarthrosis, instrumentation failure, adjacent segment disease, sacral fractures, and retroperitoneal fluid collections. 10,[16][17][18][19][20][21][22][23][24] Retroperitoneal fluid collections are an uncommon cause of delayed symptoms following an ALIF procedure. Various etiologies include hematomas, urinomas, chyloperitoneum, cerebrospinal fluid (CSF) collections, and deep infections.…”

mentioning

confidence: 99%

An unusual case of a persistent, infected retroperitoneal fluid collection 5 years after anterior lumbar fusion surgery: illustrative case

Neal¹,

Curley²,

Richards³

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUNDAnterior lumbar fusion procedures have many benefits and continue to grow in popularity. The technique has many potential approach- and procedure-related complications. Symptomatic retroperitoneal fluid collections are uncommon but potentially serious complications after anterior lumbar procedures. Collection types include hematomas, urinomas, chyloperitoneum, cerebrospinal fluid collections, and deep infections.OBSERVATIONSThe authors present an unusual case of a patient with persistent symptoms related to a retroperitoneal collection over a 5-year period following anterior lumbar fusion surgery. To the authors’ knowledge, no similar case with such extensive symptom duration has been described. The patient had an infected encapsulated fluid collection. The collection was presumed to be a postoperative lymphocele that was secondarily infected after serial percutaneous drainage procedures.LESSONSWhen retroperitoneal collections occur after anterior retroperitoneal approaches, clinical clues, such as timing of symptoms, hypotension, acute anemia, urinary tract infection, hydronephrosis, elevated serum creatinine and blood urea nitrogen, low-pressure headaches, anorexia, or systemic signs of infection, can help narrow the differential. Retroperitoneal collections may continue to be symptomatic many years after anterior lumbar surgery. The collections may become infected after serial percutaneous drainage or prolonged continuous drainage. Encapsulated, infected fluid collections typically require surgical debridement of the capsule and its contents.

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Perforated ileus after L5-S1 anterior lumbar interbody fusion: a case report presentation

Cited by 4 publications

References 13 publications

Is there a variance in complication types associated with ALIF approaches? A systematic review

Is there a variance in complication types associated with ALIF approaches? A systematic review

Sigma Perforation and Septic Peritonitis after an Anterior Lumbar: A Case Report and Literature Review

An unusual case of a persistent, infected retroperitoneal fluid collection 5 years after anterior lumbar fusion surgery: illustrative case

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