High rectal injury during trans-1 axial lumbar interbody fusion L5-S1 fixation: a case report.
METHODS
A case report.


OBJECTIVE
To report a case of high rectal injury during trans-1 axial Lumbar Interbody Fusion (axiaLIF) L5-S1 fixation.


BACKGROUND
Trans-1 axiaLIF procedure is gaining in popularity for L5-S1 fusion due to the ease of access to the sacrum through the presacral space. Normally, the midline of the sacrum at S1-S2 is relatively free from neurovascular and intra-abdominal structures, making this level a safe entry point for the axiaLIF procedure. We report a case of high rectal injury during Trans-1 axiaLIF L5-S1 procedure due to altered intra-abdominal anatomy as a result of multifactorial adhesions formation.


METHODS
A 44-year-old female patient with a history of previous anterior and posterior spinal surgeries, pelvic inflammatory disease, and non-disclosed previous diverticulitis, developed a high rectal injury during Trans-1 axiaLIF L5-S1 fixation.


RESULTS
After Trans-1 axiaLIF L5-S1, the patient presented with an episode of melena and hypogastric pain with nausea and vomiting. A computed tomography (CT) scan of the abdomen with intravenous and oral contrast showed presacral soft tissue fluid density with fat stranding and extraluminal rectal contrast and gas with some areas of soft tissue enhancement compatible with probable high rectal perforation. Patient's symptoms gradually subsided during a period of 6 months with aid from a temporary diverting ileostomy and a course of i.v. antibiotics. No spine implants were removed.


CONCLUSIONS
We report a case of high rectal injury during Trans-1 axiaLIF L5-S1 fixation and strongly advice that patients who are candidates for this surgery and have any risk factors for intra-abdominal adhesion formation, undergo a pelvic CT with rectal contrast before the surgery to evaluate for any signs of altered rectal-sacral anatomy.
Botolin
Sergiu
S
Department of Orthopaedic Surgery, University of Colorado, Denver, Colorado, USA. sergiu.botolin@ucdenver.edu
Agudelo
Juan
J
Dwyer
Anthony
A
Patel
Vikas
V
Burger
Evalina
E
D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007081:Ileostomy; D008159:Lumbar Vertebrae / Q000601:surgery*; D008551:Melena / Q000209:etiology; D009325:Nausea / Q000209:etiology; D012007:Rectum / Q000000981:diagnostic imaging / Q000293:injuries*; D012447:Sacrum / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D000267:Tissue Adhesions / Q000150:complications; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*
D000900:Anti-Bacterial Agents