Intra-abdominal aortic injury during lumbar disc surgery, a case report

Background: Intra-abdominal great vessel injury is a rare complication of lumbar intervertebral disc operations. However it may be underestimated for its unpredictable clinical manifestations. Delay in proper diagnosis and appropriate management of the sequellae often results in death of the patient. Materials and Methods: A 30-year-old man with aortic injury during L4/L5 posterior discectomy is presented and its management discussed. Conclusion: Attention of the surgical team and rapid intervention is the key factor in treatment, prevention of severe complications and even death

Post splenectomy fatal pulmonary embolism in a patient with moderate hemophilia A

Hemophilia A is a bleeding disorder caused by defective production of factor VIII. The main concern associated with the disease is bleeding, especially after trauma and surgeries. Facto VIII replacement therapy is associated with substantial decrease of bleeding events during surgery. However, there have been a number of reports of thromboemblic events in this situation. The present report describes a case of moderate hemophilia A in which splenectomy did lead to pulmonary embolism and subsequent death. The patient was a 25-year-old man with hemophilia A admitted after a car accident and trauma to left lower chest and abdomen. He received factor VIII concentrates for replacement therapy. He was hemodynamically stable on the first day, but on the second day his hemoglobin declined and he showed signs of abdominal tenderness. He, therefore, was subjected to laparatomy and splenectomy. After the operation, he suddenly developed dyspnea and decline in blood pressure, and death afterwards. Autopsy of the patient revealed massive pulmonary thromboembolism. The symptoms and outcome of the present case indicate that although pulmonary thromboembolism in the early postoperative period in patients with hemophilia A undergoing splenectomy and receiving factor VIII concentrate for replacement is rare, it should not be assumed a far-fetched event, and prophylactic measures to prevent thromboemboly must be considered