Laparatomía de emergencia por rara complicación vascular tras cirugía de hernia discal

Abstract

Posterior discectomy is a routine procedure which might present vascular complications (acute rupture, arteriovenous fistula, pseudoaneurysm), though they are very rare. Injury to the common iliac vessels is the second one in frequency, and the left common iliac artery suffers from the highest risk of injury. Fifty percent of them do not present and increased intraoperative bleeding and they should be suspected due to hypotension in the immediate postoperative period. AngioCT is the goldstandard test for abdominal vascular injury, excepting those cases of severe and uncontrollable hypovolemic shock, which requires emergent exploration of the abdomen. We present the case of a 30 year-old woman who underwent posterior discectomy and suffered hemodynamic instability after it, with partial response to crystalloid infusion. AngioCT showed retroperitoneal hematoma and active bleeding at the left common iliac artery. Emergency laparotomy was performed repairing a complete arterial section, by inserting vascular prosthesis because of a 3 cm defect between the edges. Afterwards, the patient referred ischemic symptoms in her left lower limb; and new AngioCT diagnosed partial graft thrombosis and distal embolism. Reoperation with endovascular approach was required and this complication was solved with an endovascular stent. The published mortality for acute iliac artery ruptures after discectomy reaches 20%. The multidisciplinary and coordinated management allowed a quick diagnosis and solved the emergency situation in this patient, as well as the subsequent complication, avoiding a possible fatal outcome for her.