Delayed diagnosis of vascular injuries during lumbar discectomy

We report an accident perforation of the left iliac artery and vein during lumber discectomy in the kneeling position. During the surgical procedure, a brief and transient hypotension occured, although the surgeon did not obs erve any abnormal bleeding in the operating field. In the recovery room, ar terial blood pressure decreased. and tachycardia, pallar, and abdominal pai n occurred. Retroperitoneal bleeding was suspected. Immediate fluid rescuci tation was initiated, anesthesia was continued, and red blood cells were or dered. The use of medical antishock trousers enabled temporization until va scular surgeons were ready. An emergent laparotomy was preformed to repair vascular injuries. The delayed symptoms, use of medical antishock trousers, and implications for anesthetists are discussed. (C) 2000 by Elsevier Scie nce Inc.