Deep venous thrombosis (DVT) is a significant health care problem; a variety of factors place spinal surgery patients at high risk for DVT. Our aim is to define the incidence of DVT occurrence in spite of prophylactic measures (mechanical and chemoprophylaxis), and the development of spinal epidural hematoma as a complication of chemoprophylaxis. In a single-center prospective study, 158 patients who underwent spinal surgical procedures were evaluated by clinical evaluation and lower limb Doppler ultrasonography imaging. Only one patient (0.6%) developed DVT; this patient was treated successfully without thrombus progression, with full recanalization. Three patients (1.8%) developed spinal epidural hematoma, but only one required surgical evacuation, and none sustained neurologic deficit. Careful evaluation for DVT risk on an individual basis and good prophylaxis helps to minimize the risk of DVT. The neurosurgeon is thus left to weigh the risks of postoperative hematoma formation against the benefits of protecting against DVT.Key words: Deep venous thrombosis -Pulmonary embolism -Spinal surgery -DVT prophylaxis -Low molecular weight heparin -Doppler ultrasonography D eep venous thrombosis (DVT) is a significant health care problem, causing considerable mortality and morbidity; it occurs both in medical and surgical patients. DVT is the most frequent systemic complication in patients undergoing neurosurgery. 1 Pulmonary embolism (PE) can still be fatal. 2As the complexity of spinal surgery has increased, so too has the incidence of DVT and PE. In spite of the use of different prophylactic methods, venous thromboembolism (VTE) is still a significant complication following spinal surgery. In surgery of the lumbosacral spinal, the lowest quoted rates are 0.6% for DVT and 0.3% for PE. 3The precise indications and/or timing of anticoagulation for thromboembolic prophylaxis following spinal surgery is not clear. 4 Neurosurgeons must weigh the benefits of DVT prophylaxis against the risk of bleeding complications. Unfortunately, no consensus has been reached regarding a DVT prophylaxis regimen. 5Reprint requests: Thair
Ileostomy formation is a fundamental component in the surgical management of many gastrointestinal diseases and like all intra-abdominal surgeries, small bowel obstruction is a recognized complication. In this paper we discuss a case of a 44-year-old female who previously had a loop ileostomy for slow bowel transit in the presence of spinal bifida. She presented for subsequent total colectomy because of ongoing pain due to chronic colonic dilation. At surgery, the stoma was not revised and the efferent loop was divided at the peritoneal level of the anterior abdominal wall. Six days postoperatively, the patient developed a small bowel obstruction as a result of the remnant efferent loop within the anterior abdominal wall, forming a cystic mass compressing the ileostomy, requiring surgical intervention. As far as we are aware, this is the first case of small bowel obstruction described due to this unusual etiology.
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