SMALL BOWEL INJURY FOLLOWING DEBRIDEMENT OF INFECTIOUS LUMBAR DISCITIS: A CASE REPORT

Tóm tắt

Introduction: Lumbar discectomy is a widely accepted treatment for lumbar disc herniation and infectious spondylodiscitis unresponsive to conservative therapy. While generally safe, bowel injury is an extremely rare but potentially fatal complication, with fewer than 30 cases reported worldwide. To our knowledge, no previous reports have described small bowel perforation during microdiscectomy for infectious discitis. Case Presentation: We report the case of a 52-year-old woman who developed infectious spondylodiscitis at the L5–S1 level following lumbar discectomy. Despite two revision surgeries, her symptoms persisted, and she underwent a third procedure involving anterior debridement through a posterior approach. Intraoperatively, sudden loss of resistance and leakage of irrigation fluid suggested a visceral injury. Postoperatively, she developed peritonitis, and abdominal CT revealed jejunal perforation. Emergency laparotomy confirmed a complete jejunal transection, which was repaired with side-to-end anastomosis. The patient recovered fully and remained asymptomatic at 5-year follow-up. Discussion: Small bowel injury during lumbar microdiscectomy is exceedingly rare. In this case, infectious spondylodiscitis had weakened the anterior annulus fibrosus and anterior longitudinal ligament, predisposing to perforation during debridement. Early recognition of intra-abdominal signs and prompt surgical intervention were essential to achieve a favorable outcome. Conclusion: This case highlights a novel mechanism of bowel injury during revision discectomy in the setting of infectious discitis. Surgeons should be aware of this rare but serious complication and maintain high suspicion when operating in infected or structurally compromised disc spaces.