Hepatic ischemia as a complication after correction of post-traumatic gibbus at the thoracolumbar junction

Study Design. This is a case report of hepatic ischemia secondary to celiac trunk stenosis as a complication after correction of a preoperative 30 deg rees gibbus at the thoracolumbar junction. Objectives. A high index of suspicion is needed to make a timely diagnosis of hepatic ischemia in any setting. After spinal reconstruction involving l engthening, symptoms suggestive of an acute abdomen accompanied by markedly elevated liver enzymes should be evaluated with an angiogram to check for celiac trunk stenosis. Summary of Background Data. Review of the literature showed no reported cas es of hepatic ischemia or descriptions of the status of celiac trunk stenos is after spinal surgery. Even in more commonly associated settings, diagnos is of both phenomena is often delayed, with possible morbid consequences. Methods. A case is presented of a patient who underwent gibbus correction a nd re-establishment of lost anterior intervertebral distance at the thoraco lumbar junction. After surgery, ischemic hepatitis,a perforated gallbladder , and splenic infarction developed secondary to celiac trunk stenosis-a res ult of cephalad displacement of the celiac trunk and compression of the art ery by the diaphragmatic ligament. Results. An emergent exploratory laparotomy with cholecystectomy was perfor med followed by an angiogram, which demonstrated stenosis of the celiac tru nk, After release of the arcuate ligament, the patient's condition improved rapidly, and he made a complete recovery. Conclusions. The consequences of a delay in diagnosis of hepatic ischemia c an be disastrous. An awareness of the possibility of this complication afte r spinal lengthening should facilitate a timely angiogram and operative int ervention.