Iatrogenic Left Internal Iliac Artery Perforation During Lumbar Discectomy

Received 9 May 2008; received in revised form 7 August 2008; accepted 12 August 2008.

Iatrogenic intra-abdominal vascular injury can result from lumbar discectomy via the posterior approach. Although it is well known and documented in the literature, few anesthesiologists have personal experience with this life-threatening incident. Here, we report a patient who sustained perforation of the left internal iliac artery at the L4-5 level during posterior lumbar discectomy. The patient experienced refractory hypotension with tachycardia at the end of surgery, even with prompt fluid resuscitation and medical treatment. Abdominal distension and tenderness of the left lower abdominal quadrant were also noted. Emergency laparotomy was performed by the consulting vascular surgeon and revealed perforation of the left internal iliac artery. The vascular injury was successfully repaired. It is important that, as anesthesiologists, we must be aware of this potentially fatal complication. Prompt diagnosis and immediate laparotomy to control hemorrhage can result in favorable outcomes.

KEY WORDS: discectomy, lumbar , hypotension , iliac artery, internal

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Article Outline

• Abstract

• References

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References

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a Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.

b Department of Anesthesiology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan, R.O.C.

Corresponding author. Department of Anesthesiology, National Taiwan University Hospital Yun-Lin Branch, 579, Section 2, You-Lin Road, Dou-Liu, Yun-Lin 640, Taiwan, R.O.C.

PII: S1875-4597(09)60054-0

doi:10.1016/S1875-4597(09)60054-0

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