Spontaneous healing of retroperitoneal hematoma following injury to a lateral branch of the lumbar spinal artery after percutaneous endoscopic discectomy: A case report

Abstract

Purpose: The minimally invasive percutaneous endoscopic discectomy (PED) was developed in the 20th century. Recently, the interest in minimally invasive surgery and the number of PEDs has increased. The incidence of postoperative retroperitoneal hematoma following percutaneous endoscopic discectomy was reported at 0.1 ~ 1%. We report a case of spontaneous healing of retroperitoneal hematoma following injury to a lateral branch of the lumbar spinal artery after percutaneous endoscopic discectomy. Methods: A 58-year-old male underwent percutaneous endoscopic resection of the L4-5 disc via a transforaminal approach. After 2 h, he complained of rigid abdominal pain with hypotension. Abdominal computerized tomography (CT) revealed large hematoma (1300 mL) on the right retroperitoneum. A small pseudoaneurysm was detected at a lateral muscular branch of the 4th lumbar spinal artery on angiography without contrast leakage, with no additional treatment of this lesion. Results: We performed conservative treatment at an intensive care unit. Two weeks later (POD 14 days), the patient was discharged with the hematoma almost well absorbed and small despite with bruise dorsally, without other complications. The abdominal CT obtained from the outpatient department (OPD) showed absorption of retroperitoneal hematoma without any signs of pseudo-aneurysm. Conclusions: We report a case of retroperitoneal hematoma following injury to a lateral branch of spinal artery during percutaneous transforaminal endoscopic lumbar discectomy (PELD). Bleeding occurs external to the cannulation site, and is therefore, difficult to detect it, warranting extra precaution during surgery.

Keywords

• Percutaneous transforaminal endoscopic lumbardiscectomy (PELD)
• Kambin’s triangle (KT)
• Lumbar artery
• Pseudoaneurysm
• Retroperitoneal hematoma