title: Fatal hemorrhage following sacroiliac joint fusion surgery: A case report.
abstract: Threaded pins and wires are commonly used in orthopedic practice and their migration intra- or post-operatively may be responsible for potentially serious complications. Vascular and visceral injury from intra-pelvic pin or guide-wire migration during or following hip surgery has been reported frequently in the literature and may result in progression through soft tissues with subsequent perforation of organs and vessels. In this report, we describe an autopsy case involving a 40-year old man suffering from chronic low back pain due to sacroiliac joint disruption. The patient underwent minimally invasive sacroiliac joint arthrodesis. Some intra-operative bleeding was noticed when a drill was retrieved, though the patient died postoperatively. Postmortem investigations allowed the source of bleeding to be identified (a perforation of a branch of the right internal iliac artery) and a potentially toxic tramadol concentration in peripheral blood to be measured.
authors.affiliation: University Centre of Legal Medicine, Lausanne University Hospital, Lausanne, Switzerland. Electronic address: cristian.palmiere@chuv.ch.
authors.forename: Cristian
authors.initials: C
authors.lastname: Palmiere
authors.affiliation: University Centre of Legal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Augsburger
authors.affiliation: University Centre of Legal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Maria
authors.initials: M
authors.lastname: Del Mar Lesta
authors.affiliation: University Centre of Legal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Silke
authors.initials: S
authors.lastname: Grabherr
authors.affiliation: Division of Orthopaedic Surgery and Traumatology, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Borens
mesh_terms: D000328:Adult; D001344:Autopsy; D017809:Fatal Outcome; D005548:Foreign-Body Migration; D006470:Hemorrhage / Q000150:complications*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D012446:Sacroiliac Joint / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*
keywords: Arthrodesis; Autopsy; Foreign Body Migration; Postmortem angiography; Sacroiliac joint; Tramadol