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Splenic Rupture Related to Thoracoscopic Spine Surgery

Binning, Mandy J., MD; Bishop, Frank, MD; Schmidt, Meic H., MD

doi: 10.1097/BRS.0b013e3181d290e1
Surgery
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Study Design. Case report and review of the literature.

Objective. We report a case of splenic rupture in association with thoracoscopic spine surgery.

Summary of Background Data. Complications of thoracoscopic spine surgery have been reported in the literature, including pleural effusion, pneumothorax, chyle thorax, intercostal neuralgia, cerebrospinal fluid fistula, lung injury, and great vessel injury. Although it has been reported to have occurred with other endoscopic procedures, splenic rupture has not been reported in association with thoracoscopic spine surgery.

Methods. A 60-year-old man with a T12 spine lesion underwent T12 corpectomy and fusion using a thoracoscopic approach. Intraoperatively, he became hemodynamically unstable, and postoperative abdominal computed tomography was consistent with splenic rupture.

Results. He underwent emergent splenectomy and has made a good recovery.

Conclusion. This case describes how retraction on the diaphragm during thoracoscopic spine surgery can lead to splenic injury. A high index of suspicion should be maintained in cases in which hemodynamic instability is identified despite a clean surgical field.

Although splenic rupture has been reported with other endoscopic procedures, it has not been reported in association with thoracoscopic spine surgery. This patient underwent a left-sided thoracoscopic approach to T12 corpectomy and fusion during which diaphragm retraction used because of the patient's morbid obesity caused splenic injury.

From the Department of Neurosurgery, University of Utah, Salt Lake City, UT.

Acknowledgment date: August 10, 2009. Revision date: December 3, 2009. Acceptance date: December 3, 2009.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Meic H. Schmidt, MD, Department of Neurosurgery, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT 84132; E-mail: neuropub@hsc.utah.edu

© 2010 Lippincott Williams & Wilkins, Inc.