title: Delayed diagnosis of vascular injuries during lumbar discectomy.
abstract: We report an accidental perforation of the left iliac artery and vein during lumbar discectomy in the kneeling position. During the surgical procedure, a brief and transient hypotension occurred, although the surgeon did not observe any abnormal bleeding in the operating field. In the recovery room, arterial blood pressure decreased, and tachycardia, pallor, and abdominal pain occurred. Retroperitoneal bleeding was suspected. Immediate fluid resuscitation was initiated, anesthesia was continued, and red blood cells were ordered. The use of medical antishock trousers enabled temporization until vascular surgeons were ready. An emergent laparotomy was performed to repair vascular injuries. The delayed symptoms, use of medical antishock trousers, and implications for anesthetists are discussed.
authors.affiliation: Department of Anesthesiology and Surgical Intensive Care, CHRU of Caen, France. hanouz-jl@chu-caen.fr
authors.forename: J L
authors.initials: JL
authors.lastname: Hanouz
authors.forename: A
authors.initials: A
authors.lastname: Bessodes
authors.forename: D
authors.initials: D
authors.lastname: Samba
authors.forename: J L
authors.initials: JL
authors.lastname: Gérard
authors.forename: H
authors.initials: H
authors.lastname: Bricard
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D017586:Diskectomy / Q000009:adverse effects*; D017707:Erythrocyte Transfusion; D005440:Fluid Therapy; D005676:Gravity Suits; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007083:Iliac Artery / Q000293:injuries*; D007084:Iliac Vein / Q000293:injuries*; D007431:Intraoperative Complications; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D019106:Postoperative Hemorrhage / Q000209:etiology; D011187:Posture; D012187:Retroperitoneal Space; D013610:Tachycardia / Q000209:etiology