Case Report

Acute Bowel Ischemia Following Spinal Surgery

Authors: Ali Mofredj, MD, Ibrahim Traore, MD, Brahim Beldjoudi, MD, Djelloul Aoula, MD, Raouf Douiri, MD

Abstract

Acute mesenteric ischemia is a morbid condition that may be difficult to diagnose due to nonspecific nature of its symptoms. To our knowledge, such a complication has not previously been reported after spinal surgery via the posterior approach. We describe the case of a 43-year-old woman who developed acute mesenteric ischemia several days after a surgical procedure for a lumbar spondylolisthesis via the posterior route. This chronic course is suggestive for venous intestinal ischemia. Prone position and hypotension during the procedure may have favored blood stasis and mesenteric vein occlusion in this patient with an inherited hypercoagulable state.


Key Points


* Venous intestinal ischemia is a morbid condition that remains difficult to diagnose due to the absence of specific symptoms.


* Only a “chronic course” of the disease may differentiate venous from arterial intestinal ischemia.


* The etiology of venous intestinal ischemia should be understood in terms of Virchow triad of stasis, vessel injury, and a hypercoagulable state.


* Inherited hypercoagulable states, such as prothrombin gene and MTHFR mutation, are currently recognized as common predisposing conditions.


* Early consideration of the diagnosis and a detailed knowledge about its pathogenesis could improve the prognosis.

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