• Skip to primary navigation
  • Skip to main content
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • SAGES Store
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
    • “Unofficial” Logo Products
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2024 Scientific Session Call For Abstracts
      • 2024 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Fellows Career Development Course
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES Top 21 MIS Procedures
    • SAGES Pearls
    • SAGES Flexible Endoscopy 101
    • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • OWLS
  • Log In

Bowel perforation after posterior spinal instrumentation: A rare complication.

Ernesto Miranda-Cervantes, MD, Luis Molina-Estavillo, MD, Ulises Caballero-DelaPena, MD, Mauricio Castano-Eguia, MD, Aurora Guillen-Graf, Marco Juarez-Parra, MD, Berenice Medina-Ortiz. Christus Muguerza Hospital Alta Especialidad / UDEM

INTRODUCTION

Intestinal perforation is a rare complication of lumbar instrumentation on a posterior approach. Until 2013 only 23 cases were reported.

The L4-L5 intervertebral space is the most frequent location of a herniated disk. Anterior to this intervertebral space separated only by the anterior spinal ligament, we can find the bifurcation of the aorta, the vena cava and the abdominal cavity.

CASE REPORT

A 43 year-old female presented with a 1-year history of back pain and radicular symptoms. Magnetic resonance imaging (MRI) was requested reporting a herniated intervertebral space in L4-L5 and L5-S1. Surgery was scheduled performing a laminectomy with discectomy and lumbar spinal instrumentation in the intervertebral spaces L4-L5 and L5-S1.

On her third postoperative day the patient referred diffuse abdominal pain.  Physical examination revealed absent peristalsis and rebound tenderness, without hemodynamic compromise. 

Abdominal ultrasound was realized, and approximately 100 ml of pelvic free fluid was found. A computed tomography (CT) revealed air in the spinal canal adjacent to the surgery site, pneumoperitoneum and free fluid in the paracolic gutter.(Figure 1)

Laparoscopy was performed finding abundant serohematic fluid and identifying an opening in the retroperitoneum posterior to the sigmoid colon of about 1.5 cm, metal clips were used for vascular control. (Figure 2,3)

After four days of the postoperative course the patient presented with abdominal pain, fever of 38 ° C, and leukocytosis of 33,000 K/ul, where a CT scan reveled pneumoperitoneum

Afterwards, laparotomy was performed, finding abundant inflammatory fluid and perforation of the ileum 40 cm from the ileocecal valve: we performed the resection of the affected segment and a latero-lateral anastomosis. (Figure 4)

DISCUSSION

When the patient is in prone position, the abdominal pressure causes compression of the abdominal viscera against the vertebral bodies and retroperitoneal vessels. Additionally, chronic disease can weaken the anterior spinal ligament, making the space between the vertebrae and the retroperitoneum lessen, favoring the emergence of vascular or visceral lesions. 

The clinical manifestations posterior to an intestinal injury by lumbar instrumentation are nonspecific. Pneumoperitoneum can be caused by retroperitoneal perforation without intestinal damage and the bleeding may cause peritoneal irritation.

CONCLUSION

Early diagnosis can prevent fatal outcomes, so it is of great importance to include intestinal perforation in the diagnosis of patients with abdominal pain posterior to lumbar instrumentation.

Figure 1 Figure 2 Figure 3 Figure 4

1,095

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064
1-310-437-0544
[email protected]
Monday - Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube
  • Instagram
  • TikTok

Important Links

SAGES 2024 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons