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Vascular injury after lumbar discectomy mimicking appendicitis: Report of a case.

Wee HY, Wang CC, Kuo JR - Asian J Neurosurg (2015 Jul-Sep)

Bottom Line: The diagnostic laparoscopy was done under the impression of acute appendicitis but showed a retroperitoneal hematoma.An emergency abdominal computed tomography confirmed a right iliac artery pseudoaneurysm rupture.We performed a transarterial embolization with multiple metallic coils in the aneurysm cavity and connected the proximal and distal right internal iliac artery because his hemodynamics became progressively unstable.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Chi Mei Medical Center, Liouying, Taiwan.

ABSTRACT
Right lower quadrant pain after a lumbar discectomy is a rare condition. We report on a 29-year-old man who developed right lower quadrant pain 12 h after lumbar discectomy due to the formation and rupture of a right iliac artery pseudoaneurysm. The diagnostic laparoscopy was done under the impression of acute appendicitis but showed a retroperitoneal hematoma. An emergency abdominal computed tomography confirmed a right iliac artery pseudoaneurysm rupture. We performed a transarterial embolization with multiple metallic coils in the aneurysm cavity and connected the proximal and distal right internal iliac artery because his hemodynamics became progressively unstable. In this article, in addition to presenting the clinical course of an unusual case, we also wanted to emphasize that patients with right lower quadrant pain could be presenting an early sign of pseudoaneurysm formation and rupture after a lumbar discectomy.

No MeSH data available.


Related in: MedlinePlus

Diagnostic laparoscopy was done under the impression of acute appendicitis but showed a retroperitoneal hematoma with normal appendix appearance
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Figure 1: Diagnostic laparoscopy was done under the impression of acute appendicitis but showed a retroperitoneal hematoma with normal appendix appearance

Mentions: A 29-year-old man had received an L4–L5 laminectomy and discectomy surgery 3 years prior to his admission to our ward complaining of low back pain radiating to the right lower leg for 3 months. He underwent an L45S1 laminectomy + L4/5 and L5/S1 discectomy operation. Twelve hours later, he developed right lower quadrant pain, with suspicion of acute appendicitis. The diagnostic laparoscopy showed a retroperitoneal hematoma and no acute appendicitis [Figure 1]. An emergency abdominal computed tomography showed the rupture of a pseudoaneurysm from the right internal iliac artery [Figure 2]. His hemodynamic status became unstable, so we performed a transarterial embolization with multiple metallic coils in the aneurysm cavity and connected the proximal and distal right internal iliac artery after angiography diagnosis [Figures 3 and 4]. After the embolization and a massive fluid and blood transfusion, his hemodynamic status stabilized. Finally, he was discharged smoothly and reported no new neurological problems 10 days after admission.


Vascular injury after lumbar discectomy mimicking appendicitis: Report of a case.

Wee HY, Wang CC, Kuo JR - Asian J Neurosurg (2015 Jul-Sep)

Diagnostic laparoscopy was done under the impression of acute appendicitis but showed a retroperitoneal hematoma with normal appendix appearance
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553744&req=5

Figure 1: Diagnostic laparoscopy was done under the impression of acute appendicitis but showed a retroperitoneal hematoma with normal appendix appearance
Mentions: A 29-year-old man had received an L4–L5 laminectomy and discectomy surgery 3 years prior to his admission to our ward complaining of low back pain radiating to the right lower leg for 3 months. He underwent an L45S1 laminectomy + L4/5 and L5/S1 discectomy operation. Twelve hours later, he developed right lower quadrant pain, with suspicion of acute appendicitis. The diagnostic laparoscopy showed a retroperitoneal hematoma and no acute appendicitis [Figure 1]. An emergency abdominal computed tomography showed the rupture of a pseudoaneurysm from the right internal iliac artery [Figure 2]. His hemodynamic status became unstable, so we performed a transarterial embolization with multiple metallic coils in the aneurysm cavity and connected the proximal and distal right internal iliac artery after angiography diagnosis [Figures 3 and 4]. After the embolization and a massive fluid and blood transfusion, his hemodynamic status stabilized. Finally, he was discharged smoothly and reported no new neurological problems 10 days after admission.

Bottom Line: The diagnostic laparoscopy was done under the impression of acute appendicitis but showed a retroperitoneal hematoma.An emergency abdominal computed tomography confirmed a right iliac artery pseudoaneurysm rupture.We performed a transarterial embolization with multiple metallic coils in the aneurysm cavity and connected the proximal and distal right internal iliac artery because his hemodynamics became progressively unstable.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Chi Mei Medical Center, Liouying, Taiwan.

ABSTRACT
Right lower quadrant pain after a lumbar discectomy is a rare condition. We report on a 29-year-old man who developed right lower quadrant pain 12 h after lumbar discectomy due to the formation and rupture of a right iliac artery pseudoaneurysm. The diagnostic laparoscopy was done under the impression of acute appendicitis but showed a retroperitoneal hematoma. An emergency abdominal computed tomography confirmed a right iliac artery pseudoaneurysm rupture. We performed a transarterial embolization with multiple metallic coils in the aneurysm cavity and connected the proximal and distal right internal iliac artery because his hemodynamics became progressively unstable. In this article, in addition to presenting the clinical course of an unusual case, we also wanted to emphasize that patients with right lower quadrant pain could be presenting an early sign of pseudoaneurysm formation and rupture after a lumbar discectomy.

No MeSH data available.


Related in: MedlinePlus