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 observe any abnormal bleeding in the operating field. In the recovery room, arterial blood pressure decreased. and tachycardia, pallar, and abdominal pain occurred. Retroperitoneal bleeding was suspected. Immediate fluid rescucitation was initiated, anesthesia was continued, and red blood cells were ordered. The use of medical antishock trousers enabled temporization until vascular 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 Science Inc.