LUMBAR SURGERY LEADS TO BOWEL PERFORATION

Patient developed severe abdominal pain immediately after the performance of L4-S1 laminectomy and fusion with hardware. Thereafter, she had several CT Scans which indicated a bowel perforation. The following morning, patient underwent a laparotomy to repair a small bowel perforation. The pathology report for the laparotomy indicated that a bone fragment was seen within the area of intestinal disruption.

Patient was only advised he was going to have a one level laminectomy and fusion L5-S1, but MD instead performed a two level laminectomy and fusion. The consent form did not contain any warnings about a bowel injury and the bowel is nowhere near where he was operating. Patient experienced a number of medical problems (bladder spasms, severe abdominal pain, anemia, pleuritic chest pain and atelectasis) in the post laparotomy period and was re-admitted on several occasions for post-operative wound infection fevers and anemia.

Is bowel perforation a known complication of spinal surgery and is there an informed consent issue?

MEDQUEST EXPERT RESPONSES

Vascular and intestinal injuries after lumbar surgeries are fairly well described. In general, they are defensible. The patients usually do quite well after the belly surgery with a complete recovery. There may well be an informed consent issue but likely limited damages. Dr. SS – Neurosurgeon

It is uncommon, but intestinal perforation does occur from spine surgery. It is probably not as rare as the literature indicates, as most cases do not make it into the literature. Most surgeons would not mention it in a discussion of surgical risks because of its great infrequency. Dr. JH – Neurosurgeon

I agree that there is concern if the operation was performed differently than the consent form process prepared the patient and if the complication was not discussed as a possibility in the consent form process. However, bowel injuries are well known complications of spinal surgery with interbody fusions and instrumentation with pedicle screws. Therefore, the case appears to revolve around consent. They could claim that intraoperative findings led to the extra-level being performed and that the complication is not due to poor technique since it has been described by very good centers in the literature. Dr. SB – Neurosurgeon