Small Bowel Perforation as a Complication of Microsurgical Lumbar Diskectomy

Hoff-Olsen, P.; Wiberg, J.

doi:10.1097/00000433-200109000-00025

Cited by 11 publications

(18 citation statements)

References 19 publications

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“…There have been 18 cases in the surgical literature reporting bowel injury 2,[8][9][10][11][12][13][14][15] Intestinal injury most frequently involved the ileum, with other injuries to sigmoid, cecum, appendix, and jejunum documented. Discovery of bowel injury rarely occurs intraoperatively, or in the recovery room.…”

Section: Discussionmentioning

confidence: 99%

Bowel Injury following Lumbar Discectomy using Minimally Invasive Retractors

Cenic

Sne

Lisi

et al. 2007

Can. j. neurol. sci.

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Prevalence of symptomatic lumbar disc herniation is 1-3% in the adult population.1 When conservative therapy (e.g., physiotherapy, anti-inflammatories, epidural injections, etc.) fails, open microsurgical discectomy is regarded as the treatment of choice. With this procedure, the incidence of injury to visceral bowel is reported to be 3.8 per 10,000 cases. 2 With the recent advent of tubular retractor systems, an increasing number of surgeons are using this minimally invasive procedure to replace traditional open microsurgical discectomy. The advantages include a smaller skin incision and a muscle splitting rather than muscle incising technique. As a result post-operative pain, blood loss and length of hospital stay may decrease significantly. [3][4][5][6] Multiple studies have compared the two surgical techniques with regards to their clinical outcomes. 6,7 The results of these studies reveal equal if not superior clinical outcomes with the minimally invasive technique. Despite the success of the minimally invasive microdiscectomy, none of the studies reported any intraoperative complications using this novel technique. This report represents the first documented bowel injury using METRx tubular retractors (Medtronic Sofamor-Danek, Memphis, TN) for minimally invasive lumbar microsurgical discectomy. CASE REPORT Clinical HistoryA 36 year old female with severe back pain, and right lower limb radicular symptoms referred to Neurosurgery to assess for possible surgical intervention. Magnetic resonance imaging (MRI) of lumbar spine revealed L5-S1 paramedian disc herniation which was consistent with clinical findings (see Figures 1a & 1b). Trial of conservative therapy was not effective hence, patient agreed to have lumbar discectomy done. The less invasive method of using METRx tubular retractors for the discectomy was offered to the patient. The patient agreed to the procedure upon discussion of potential benefits and possible complications. Minimally Invasive MicrodiscectomyUnder general anesthesia, the patient was placed prone on the Wilson frame. Using fluoroscopy, a Kirschner wire was docked onto the right side of the L5 lamina and a 1.5cm skin incision was made. The METRx tubular retractor was then introduced in standard fashion over sequential dilators and the microscope brought in. Following laminotomy and removal of ligamentum flavum, the anticipated large disc herniation distorting the S1 nerve root was encountered. The disc was incised, and the THE CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES 485Bowel Injury following Lumbar Discectomy using Minimally Invasive Retractors Aleksa Cenic, Niv Sne, Michael Lisi, Allan Okrainac, Kesava Reddy, Can. J. Neurol. Sci. 2007; 34: 485-487 PEER REVIEWED LETTER fragment removed with pituitary rongeurs. The end-plates of L5 and S1 were scraped using reverse-angled curettes. Copious bacitracin irrigation of the disc space was performed ensuring no residual loose disc pieces. Upon inspection, the nerve root was well decompressed. Hemostasis was achieved with bone wax 3193...

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Section: Discussionmentioning

confidence: 99%

Bowel Injury following Lumbar Discectomy using Minimally Invasive Retractors

Cenic

Sne

Lisi

et al. 2007

Can. j. neurol. sci.

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“…O primeiro relato de lesão aórtica foi em 1948 27 . Manifestações clínicas podem ser extremamente variáveis quando ocorre perfuração do ligamento longitudinal anterior, com lesões de grandes vasos (aorta, ilíacos, veia cava inferior, lombares, renal), bexiga, intestinos delgado e grosso, útero, formação de falso aneurisma, fístula arteriovenosa, apêndice e cadeia simpática 14,[28][29][30][31][32][33][34][35][36][37][38] . A aorta abdominal está à esquerda do ligamento longitudinal anterior e bifurca justamente acima do 4º disco lombar.…”

Section: Discussionunclassified

“…A literatura sugere que os cirurgiões não consideram que perfuraram o ligamento longitudinal anterior, mas enfatizam o risco de perfuração de grandes vasos. Hipotensão arterial ou taquicardia inexplicada podem ocorrer no per e pós-operatório confundindo-se com complicações anestésicas, infarto do miocárdio, choque cardiogênico, embolia pulmonar, embolia aérea, reações alérgicas, regurgitação mitral aguda e cardiopatia hipertrófica obstrutiva [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] . O diagnóstico pode permanecer obscuro até o paciente retornar à posição supina e ser encaminhado para a SRPA e manifestar-se clinicamente.…”

Section: Discussionunclassified

Lesão da artéria ilíaca esquerda durante laminectomia lombar: relato de caso

Moreira

Xavier

2003

Rev. Bras. Anestesiol.

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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.

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“…Although the prognosis of bowel injury after lumbar discectomy is not dismal compared to that of vascular injury, the fatal course was led by generalized peritonitis with septisemia 7) or concomitant vascular injury possibly induced by chronic infection. Considering delay in diagnosis is associated with a high morbidity and mortality rate after bowel injury, especially with small bowel perforation 3) , exploratory laparotomy following prompt diagnostic evaluation should be performed to repair the injured intestine using a primary suture or resection and anastomosis.…”

Section: Figmentioning

confidence: 99%

“…While the incidence and description of common complications related to this procedure are well known, isolated intestinal injury after lumbar discectomy is a rare but distressing complication. There have been reports of 18 cases of bowel injury as a complication of lumbar discectomy [6][7][8]12,[15][16][17] . This paper documents an additional case with relevant imaging findings and presents the diagnostic, etiological and preventive aspects of this complication.…”

Section: Introductionmentioning

confidence: 99%

Small Bowel Injury as a Complication of Lumbar Microdiscectomy : Case Report and Literature Review

Kim

Lee

Moon

et al. 2010

J Korean Neurosurg Soc

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Small bowel injury resulting from unforeseen penetration of the anterior annulus fibrosus and longitudinal ligament is a rare complication of lumbar microdiscectomy. The patient complained of abdominal tenderness and distention immediately after microdiscectomy for L4-5 and L5-S1 disc herniation. Using abdominal computed tomography, we found several foci of air overlying the anterior aspect of the vertebral body at the L5-S1 level. Segmental resection of the small bowel including small tears and primary anastomosis of the jejunum were performed. Here, we present a case of intestinal perforation after lumbar microdiscectomy and discuss technical methods to prevent this complication with a review of literature.

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Small Bowel Perforation as a Complication of Microsurgical Lumbar Diskectomy

Cited by 11 publications

References 19 publications

Bowel Injury following Lumbar Discectomy using Minimally Invasive Retractors

Bowel Injury following Lumbar Discectomy using Minimally Invasive Retractors

Lesão da artéria ilíaca esquerda durante laminectomia lombar: relato de caso

Small Bowel Injury as a Complication of Lumbar Microdiscectomy : Case Report and Literature Review

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