title: [Hepatic artery aneurysm rupture after lumbar stenosis surgery. Medico-legal thinking].
abstract: BACKGROUND
  Distinguishing between therapeutic contingency and surgical complication is sometimes not easy, especially when rare events occur. We report the case of a patient who presented with an intraperitoneal haemorrhage following laminectomy and discuss the implications of surgery in this complication.
  
  
  METHODS
  A 77-year-old woman, suffering from radiculopathy due to lumbar stenosis underwent a laminectomy in the prone position. On admission she presented with high blood pressure and obesity as significant comorbidities. A few hours after surgery, she collapsed and underwent a thoraco-abdominal CT-scan. The examination revealed a ruptured hepatic artery aneurysm. It is the first case published in the medical literature after lumbar surgery. The aim of this article was to discuss the responsibility of the surgeon and surgery, particularly the surgical positioning of the ruptured aneurysm.
  
  
  CONCLUSIONS
  After reviewing the literature we did not find any evidence to attribute the rupture of this hepatic artery aneurysm to lumbar surgery. This adverse event could be attributed to therapeutic contingency. In cases of patient complaint, this situation depends on national solidarity.
authors.affiliation: Service de neurochirurgie A, hôpital universitaire Pellegrin, université Bordeaux Segalen, place Amélie-Raba-Léon, 33076 Bordeaux, France.
authors.forename: V
authors.initials: V
authors.lastname: Jecko
authors.affiliation: Service de médecine légale, hôpital universitaire Pellegrin, université Bordeaux Segalen, place Amélie-Raba-Léon, 33076 Bordeaux, France.
authors.forename: L
authors.initials: L
authors.lastname: Benali
authors.affiliation: Cabinet d'avocats, 17, rue des Trois Conils, 33000 Bordeaux, France.
authors.forename: J-F
authors.initials: JF
authors.lastname: Vignes
authors.affiliation: Service de neurochirurgie A, hôpital universitaire Pellegrin, université Bordeaux Segalen, place Amélie-Raba-Léon, 33076 Bordeaux, France. Electronic address: jean-rodolphe.vignes@chu-bordeaux.fr.
authors.forename: J-R
authors.initials: JR
authors.lastname: Vignes
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D003251:Constriction, Pathologic / Q000601:surgery*; D005260:Female; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects*; D011183:Postoperative Complications; D011843:Radiculopathy / Q000209:etiology; D016896:Treatment Outcome
keywords: Abdominal cavity pressure; Aspects médico-légaux; Canal lombaire étroit; Complication; Décubitus ventral; Lumbar stenosis; Medico-legal aspects; Postoperative; Postopératoire; Pression intra-abdominale; Prone position