We report persistent postoperative paraplegia on recovery from anesthesia after emergent exploratory laparotomy for large bowel obstruction in a cachectic patient with an abdominal aortic aneurysm. Postoperative cervical, thoracic, and lumbar spine magnetic resonance imaging revealed only cervical spinal stenosis. We hypothesize that intraoperative embolization possibly caused by manipulation of an atherosclerotic aorta, and a brief episode of intraoperative hypotension resulted in spinal cord ischemia. This report highlights the importance of maintaining intraoperative hemodynamic stability and careful handling of the abdominal aorta, especially in underweight patients with an abdominal aortic aneurysm.
From the *Department of Medicine, University of Texas Medical Branch at Galveston, Galveston, Texas
†Department of Physical Medicine and Rehabilitation, University of Texas at Austin–Dell Medical School, Austin, Texas
Departments of ‡Medicine
§Anesthesiology, Baylor College of Medicine, Houston, Texas
‖Department of Anesthesiology, Michael E. Debakey Veterans Affairs Medical Center, Houston, Texas.
Accepted for publication December 8, 2017.
The authors declare no conflicts of interest.
Address correspondence to Ronan Allencherril, BA, Department of Medicine, University of Texas Medical Branch at Galveston, 301 University Blvd, Galveston, TX 77555. Address e-mail to firstname.lastname@example.org.