[Hemorrhagic shock caused by iatrogenic aorto-cava injury. Case report].
BACKGROUND
Vascular injuries during lumbar disc surgery vary between 1 and 5 per 10,000 disc operations and usually represent life-threatening events.


METHODS
The authors present a case of aorto-iliac and ICY laceration during lumbar disc hernia repair, successfully treated with immediate damage control and direct suture, followed by endovascular procedure.


METHODS
A 34-year-old lady was operated on for a symptomatic disc herniation at L4-L5. Shortly after this procedure, an ipovolemic shock (IV degree) suddenly occurred with an evident abdominal distension. An emergent laparotomy in the same neurosurgery OR was then performed and revealed an active haemorrhage arising fJom an expansive retroperitoneal bleeding at the level of aorto-iliac bifurcation. After a proximal and distal damage control (manual compression plus aortic clamping) aortic and caval lacerations were repaired. An abdominal packing completed the procedure, due to the concomitant coagulopathy applied. At the second surgical look, carried out 24 hours after the first procedure, no active bleeding or vascular impairment were detected but an intraoperative US examination revealed a 3.5 cm wide right iliac pseudoaneurism confirmed by angioCT scan. This pseudoaneurism was later successfully treated with a double endovascular stenting. Postoperative outcome was uneventful and the patient was then discharged 11 days after the discectomy. Follow up study at 2 years did not demonstrate significant sequels.


CONCLUSIONS
Although rare, vascular injuries during lumbar disc hernia surgery, are extremely severe complications, leading to high morbidity and mortality rates. In case of massive bleeding the presence of an "intrahospital" trauma team is a crucial factor for life-saving.
Gentile
Valerio
V
Azienda Ospedaliera Universitaria Pisana, U.O. Chirurgia Generale e d'Urgenza, Dipartimento di Chirurgia, Universittà di Pisa. docgentile@fastwebnet.it
Musco
Barbara
B
Della Giovampaola
Claudio
C
Lippolis
Piero Vincenzo
PV
Seccia
Massimo
M
D000328:Adult; D001012:Aorta, Abdominal / Q000293:injuries*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D007431:Intraoperative Complications; D008159:Lumbar Vertebrae; D012771:Shock, Hemorrhagic / Q000209:etiology*; D014682:Vena Cava, Inferior / Q000293:injuries*