Temporary postoperative visual loss associated with intracerebral hemorrhage after laparoscopic appendectomy: a case report

Abstract

Postoperative visual loss (POVL) after non-ophthalmic surgery is rare, with a reported incidence ranging from 0.013 to 0.2%. Most perioperative visual loss is associated with spine operations and cardiac bypass procedures. The most common cause of POVL is ischemic optic neuropathy. However, there are no previous reports of postoperative visual loss after laparoscopic appendectomy. A 43-year-old female with no underlying disease underwent laparoscopic appendectomy; the operation was completed in one hour and her blood pressure was stable during the perioperative period. In the post-anesthetic care unit, the patient complained of nausea and headache, but she did not complain of any unusual visual symptoms. Approximately one hour after arriving at the ward, the patient complained of visual disturbance. Neurologic examination revealed left homonymous hemianopsia, and subarachnoid hemorrhage and intracerebral hemorrhage were found in the occipital area on brain MRI.

Post Appendectomy Blindness, Extremely rare complication after abdominal surgery

“…The prevalence of perioperative visual loss in the United States, over a 10 years period reported that the national estimate in cardiac surgery was 8.64/10,000 and 3.09/10,000 in spinal fusion. After searching PubMed and Google scholar, only one case of post appendectomy visual loss was reported from Korea, in 2014 [5] . Risk factors include hypotension and the use of vasopressor as with our patient, other including prone position, long duration of surgery, massive bleeding and increased venous pressure.…”

Perioperative Blindness in Spine Surgery: A Scoping Literature Review

“…With respect to cardiac surgery, ION and CRAO remain the most common pathologies; however, the mechanisms often reflect cardiogenic or vascular processes such as aortic insufficiency, transient cerebral ischemia, carotid artery stenosis, embolic stroke, or atrial myxoma, and the risk is elevated with valve surgeries [76,77]. Few cases of POVL following colorectal procedures have been reported and the mechanism remains poorly understood [78,79].…”

Perioperative adrenergic response and the use of beta-blockers

“…The majority of post-operative neurologic deficits in adult patients are due to thromboembolic complications in the medium- or small-sized vascular system, and transient or persistent interruption of regional perfusion to a region subjected to a specific neurologic deficit. Therefore, the use of carbon dioxide (CO 2 ), to establish pneumoperitoneum, and its risk for producing gas emboli should be considered during laparoscopic surgery, even in patients who do not have underlying condition neurologic deficit, as per a report presented in the present issue [ 9 ]. In this case, greater intra-abdominal pressure, due to increased CO 2 insufflation pressure, impeded venous return, even in the cerebral venous system, dissolved CO 2 gas-generated intense vascular dilatation and a large number of embolic bubbles in the cerebrovascular system.…”