Late-Onset Bowel Perforation and Iliac Artery Erosion After Prominent Anterior Spinal Instrumentation

Abstract

In Brief Study Design. Case report. Objective. To report a rare complication of anterior spine surgery and instrumentation. Summary of Background Data. Anterior spinal fusion and instrumentation are now frequently used for the treatment of a variety of complex spinal disorders. Several authors have discussed the complications of such procedures. Late perforation of large bowel along with erosion of major vessel after anterior spinal instrumentation is a rare occurrence. Methods. We present a case of 53-year-old woman who presented with unusual abdominal pain and bleeding of the rectum. She had undergone spine surgery for L5 burst fracture 5 years ago. A detailed evaluation showed perforation of rectosigmoid colon and erosion of left common iliac artery by the anterior spine implants. Results. The bowel was repaired and arterial reconstruction was done along with spine implant removal. The patient had complete recovery of symptoms after the treatment. Conclusion. Delayed visceral injury with anterior spine surgeries is rare. Early diagnosis is possible with a high degree of suspicion. Meticulous surgical techniques may avoid this complication. We are reporting an unusual case of delayed perforation of rectosigmoid colon and erosion of left common iliac artery after anterior spine surgery. The bowel was repaired and arterial reconstruction was done along with spine implant removal. Following of meticulous surgical instrumentation techniques and use of low-profile implants may avoid occurrence of these injuries.