Introduction: Accidental retroperitoneal great vessel injury is a rare and potentially fatal complication
of lumbar spine surgical procedures. It was first reported in 1945. The main challenge
in the management of these cases remains in early diagnosis and proper treatment,
which consists of immediate open surgical repair or by minimally invasive endovascular
treatment through digital subtraction angiography using stent grafts.
Case Presentation: A patient submitted to a L4–L5 level microdiscectomy, with no complications during
the procedure, evolved with diaphoresis, disorientation, mild tachycardia and hypotension
with transient response to intravenous infusion of saline solution in the postoperative
period. Physical assessment reveals no major signal of disease, and the hemoglobin
level decreased from 12.6 g/dL preoperatively 7.7 g/dL. An abdominal Doppler ultrasound
reveals no abnormal findings, and so, abdominal Computed Tomography Angiography (CTA)
showed retroperitoneal hematoma and pseudoaneurysm along the left common iliac artery.
The patient was submitted to digital subtraction angiography to implant a stent graft,
achieving successful obliteration of the false aneurysm.
Discussion: Accidental retroperitoneal great vessel injury is unusual but possibly fatal when
performing lumbar spine surgical procedures, with an estimated incidence of 0.01 to
0.05%. Without prompt diagnosis and appropriate treatment, the prognosis is poor,
with high mortality rates. Large vessel injuries are most often found during discectomies
of L4–L5 and L5–S1 levels, at the left side due to its anatomical proximity to the
operative site and relative immobility. Massive hemorrhage during perioperative time
is unusual, allowing surgeons to suspect and correct diagnose and treat this complication.
