Unnoticed small bowel perforation as a complication of lumbar discectomy

Cases-Baldó, María José; Soria-Aledo, Víctor; Miguel-Perelló, Joana; Aguayo-Albasini, José Luís; Hernández, Maria Remedios

doi:10.1016/j.spinee.2010.10.018

Cited by 6 publications

(10 citation statements)

References 12 publications

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“…In one article, the authors described a case of abrasion of the rectum and symptoms of tenesmus without complete injury after an axial lumbar interbody fusion (AxiaLIF) procedure (33). Twelve publications described bowel injury following lumbar disc surgery or lumbar microdiscectomy (13,(17)(18)(19)(20)22,26,(28)(29)(30)(31)(32). In one publication, bowel injury occurred during sacrectomy for tumor removal (34).…”

Section: Resultsmentioning

confidence: 99%

Bowel injury in lumbar spine surgery: a review of the literature

et al. 2018

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Although rarely documented in the medical literature, bowel perforation injury can be a severe complication of spine surgery. Our goal was to review current literature regarding this complication and study possible methods of avoidance. We conducted a literature search in the PubMed database between January 1960 and March 2016 using the terms abrasion, bowels, bowel, complication, injury, intestine, intra-abdominal sepsis/shock, perforation, lumbar, spine, surgery, visceral. Diagnostic criteria, outcomes, risk factors, surgical approach, and treatment strategy were the parameters extracted from the search results and used for review. Thirty-one patients with bowel injury were recognized in the literature. Bowel injury was more frequent in patients who underwent lumbar discectomy and microdiscectomy (18 of 31 patients, 58.1%). Minimally invasive surgery and lateral techniques involving fusions accounted for 10 of the reported cases (32.3%). Finally, 2 cases (6.5%) were reported in conjunction with sacrectomies and 1 case (3.2%) with posterior fusion plus anterior longitudinal ligament (ALL) release. Diagnosis was made mostly by clinical signs/symptoms of acute abdominal pain, post-surgical wound infection, and abscess or enterocutaneous fistulas. Significant risk factors for postoperative bowel injury were complex surgical anatomy, medical history of previous abdominal surgeries or infections, irradiation before surgery, errors related to surgical technique, lack of surgical experience, and instrumentation failure. The overall mortality rate from bowel injury was 12.9% (4 of 31 patients). The overall morbidity rate was 87.1% (27 of 31 patients). According to our review of the literature, bowel injury is linked to significant morbidity and mortality. It can be prevented with meticulous pre-surgical planning. When it occurs, timely treatment reduces the risks of morbidity and mortality.

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Section: Resultsmentioning

confidence: 99%

Bowel injury in lumbar spine surgery: a review of the literature

et al. 2018

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“…When considering the supportive anatomy of the vertebral column, specifically the annulus fibrosus and the anterior longitudinal ligament, it is not inconceivable that ventral perforation is a rather rare complication of laminectomy. In a study of 30,000 lumbar discectomies, there was a reported ventral perforation rate of 0.016% [ 8 ] and when reviewing another study of documented cases it appears that this would be even less common during a laminectomy [ 7 ]. This seems logical that laminectomies would be a rarer cause of anterior perforation as the lamina is located dorsally on the vertebral body and the bowel and retroperitoneal vasculature lies anterior to the vertebral body.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of intestinal injury following lumbar discectomy was reported, in a large-scale study with 68,329 patients, to be 0.0015% by the German Society of Neurological Surgery [ 8 ]. Thorough literature search identified this as the 16th reported case of small bowel injury occurring after a discectomy or laminectomy, dating back to the first reported case by Harbison in 1954 [ 7 , 13 , 14 ]. Of all of the cases discovered in the review of the literature, we believe that this is the 2nd reported case of small bowel injury after a laminectomy [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Thorough literature search identified this as the 16th reported case of small bowel injury occurring after a discectomy or laminectomy, dating back to the first reported case by Harbison in 1954 [ 7 , 13 , 14 ]. Of all of the cases discovered in the review of the literature, we believe that this is the 2nd reported case of small bowel injury after a laminectomy [ 7 ]. The most likely mechanism by which the small bowel may be penetrated is due to the root of the mesentery arising from the anterior vertebral column at approximately L2, traveling obliquely and terminating at the right sacroiliac joint.…”

Section: Discussionmentioning

confidence: 99%

“…However, this case illustrates one of the rare instances where the small bowel was injured during a lumbar laminectomy and highlights the importance of recognizing the acute abdomen as a potentially lethal complication of a laminectomy or discectomy. Furthermore, a review of the literature revealed that this uncommon complication is more likely during a discectomy when compared to a laminectomy, which makes our reported case an exceptionally rare report [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Small Bowel Perforation as a Postoperative Complication from a Laminectomy

Krieger

Wójcicki

Berry

et al. 2015

Case Reports in Surgery

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Chronic low back pain is one of the leading chief complaints affecting adults in the United States. As a result, this increases the percentage of patients that will eventually undergo surgical intervention to alleviate debilitating, chronic symptoms. A 37-year-old woman presented ten hours postoperatively after a lumbar laminectomy with an acute abdomen due to the extraordinarily rare complication of small bowel injury secondary to deep surgical penetration.

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