Background:Recurrent lumbar disc herniation (LDH) is a common cause of poor outcomes after lumbar discectomy surgery. Studies focused on risk factors of true recurrent disk herniation at the same level and side, are few. The aim of current study is to evaluate risk factors of recurrent disc herniation in Iranian population.Materials and Methods:We retrospectively reviewed 40 patients with recurrent disc herniation and 120 patients without recurrence to evaluate possible risk factors for herniation recurrence. A clinically significant recurrent herniation was defined as a disc herniation causing leg pain with radiographic (MRI) evidence of disc material at the same side and level of the index surgery causing impingement, compression, or deviation of nerve tissue. A series of patients without recurrence was used for comparison to identify possible risk factors for recurrent LDH.Results:There was significant difference between groups with and without LDH in sex (P = 0.003), smoking habit (P = 0.004), height (P = 0.04), weight (P = 0.006) and occupational characteristic (P < 0.001). By putting these differences in logistic regression analysis, it showed that gender (male), taller height, heavy works and being smoker could predict lumbar disc herniation recurrence.Conclusion:Considering sex, smoking and heavy works as predictors of recurrent LDH, surgeons should advice their patients to limit hard work and put away smoking especially in tall and male ones to prevent LDH recurrence.

IntroductionPortal system ischemia may present insidiously which may aggravates the prognosis.Case presentationA 26-year old man presented with watery diarrhea and generalized abdominal pain for 3 months. On physical examination, moderate splenomegaly was noticeable. Stool exam and culture was negative except for blood in stool. Colonoscopy was in favor of inflammatory bowel disease although the patient symptoms have worsened despite treatment. Abdominopelvic computed tomography (CT) showed thromboses in portal and superior mesenteric veins and as the ill patient evolved signs of peritonitis, he underwent laparotomy during which, total colectomy was performed due to significant bowel necrosis. The cause of venous thrombosis of the portal system revealed to be Factor V Leiden and the presence of antiphospholipid syndrome.ConclusionHigh mortality rates of portal and mesenteric thromboses despite therapy urge the need for early clinical suspicion, careful assessment of the differential diagnoses and timely treatment for fewer adverse events. Although the therapeutic plan is challenging, anticoagulation, angiography and surgical resection increase survival.

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