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Review
. 2018 Mar;4(1):130-137.
doi: 10.21037/jss.2018.03.10.

Bowel injury in lumbar spine surgery: a review of the literature

Ioannis Siasios  1   2 , Kunal Vakharia  1   2 , Asham Khan  1   2 , Joshua E Meyers  1   2 , Samantha Yavorek  2 , John Pollina  1   2 , Vassilios Dimopoulos  1   2
Affiliations
Review

Bowel injury in lumbar spine surgery: a review of the literature

Ioannis Siasios et al. J Spine Surg. 2018 Mar.

Abstract

Although rarely documented in the medical literature, bowel perforation injury can be a severe complication of spine surgery. Our goal was to review current literature regarding this complication and study possible methods of avoidance. We conducted a literature search in the PubMed database between January 1960 and March 2016 using the terms abrasion, bowels, bowel, complication, injury, intestine, intra-abdominal sepsis/shock, perforation, lumbar, spine, surgery, visceral. Diagnostic criteria, outcomes, risk factors, surgical approach, and treatment strategy were the parameters extracted from the search results and used for review. Thirty-one patients with bowel injury were recognized in the literature. Bowel injury was more frequent in patients who underwent lumbar discectomy and microdiscectomy (18 of 31 patients, 58.1%). Minimally invasive surgery and lateral techniques involving fusions accounted for 10 of the reported cases (32.3%). Finally, 2 cases (6.5%) were reported in conjunction with sacrectomies and 1 case (3.2%) with posterior fusion plus anterior longitudinal ligament (ALL) release. Diagnosis was made mostly by clinical signs/symptoms of acute abdominal pain, post-surgical wound infection, and abscess or enterocutaneous fistulas. Significant risk factors for postoperative bowel injury were complex surgical anatomy, medical history of previous abdominal surgeries or infections, irradiation before surgery, errors related to surgical technique, lack of surgical experience, and instrumentation failure. The overall mortality rate from bowel injury was 12.9% (4 of 31 patients). The overall morbidity rate was 87.1% (27 of 31 patients). According to our review of the literature, bowel injury is linked to significant morbidity and mortality. It can be prevented with meticulous pre-surgical planning. When it occurs, timely treatment reduces the risks of morbidity and mortality.

Keywords: Bowel; complication; lumbosacral spine surgery; perforation injury.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

References

    1. Mulari K, Leppaniemi A. Severe secondary peritonitis following gastrointestinal tract perforation. Scand J Surg 2004;93:204-8. 10.1177/145749690409300306 - DOI - PubMed
    1. Karlsson S, Varpula M, Ruokonen E, et al. Incidence, treatment, and outcome of severe sepsis in ICU-treated adults in Finland: the Finnsepsis study. Intensive Care Med 2007;33:435-43. 10.1007/s00134-006-0504-z - DOI - PubMed
    1. Sartelli M, Catena F, Ansaloni L, et al. Complicated intra-abdominal infections worldwide: the definitive data of the CIAOW Study. World J Emerg Surg 2014;9:37. 10.1186/1749-7922-9-37 - DOI - PMC - PubMed
    1. Leppäniemi A, Kimball EJ, De Laet I, et al. Management of abdominal sepsis - a paradigm shift? Anaesthesiol Intensive Ther 2015;47:400-8. 10.5603/AIT.a2015.0026 - DOI - PubMed
    1. Moses ZB, Mayer RR, Strickland BA, et al. Neuronavigation in minimally invasive spine surgery. Neurosurg Focus 2013;35:E12. 10.3171/2013.5.FOCUS13150 - DOI - PubMed

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