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Small Bowel Transection as a Rare Complication of Lumbar Disc Surgery: Report of a Case.

Zafer Kilbas, Gokhan Yagci, Ismail Hakki Ozerhan, Yusuf Peker, Sadettin Cetiner.

Abstract
Small bowel injury resulting from the perforation of anterior longitudinal ligament during lumbar disc surgery is very rare, with prompt diagnosis being difficult. In the present study, we present a case of intestinal transection and discuss technical methods to prevent this complication with a review of literature. A 34-year-old woman, who had a history of lumbar disc surgery one day before, presented with abdominal pain. On physical examination, rebound tenderness and muscular rigidity were obtained, with emergency abdominal computed tomography confirming the diagnosis of perforation by showing free air and free fluid. The patient underwent laparoscopic exploration; the small bowel was found transected 60 cm proximally to the ileocecal valve. Since there were no signs of generalized peritonitis, the abdomen was irrigated with sterile saline, and side-to-side ileal anastomosis was performed. Her postoperative course was uneventful and she was discharged on the postoperative fifth day. Although bowel perforation after discectomy rarely occurs, it might be very fatal unless a prompt diagnosis is achieved. Especially, an early postoperative course can mask the symptoms and signs. Therefore, general surgeons should be aware of such a complication after lumbar disc surgery, and spine surgeons must be more cautious while they are using retractors in the intervertebral space.

Key words: Lumbar disc surgery, intraabdominal complication, bowel perforation, discectomy



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