Allencherril Ronan, Pally Annie, Allencherril Joseph, Joseph Linda
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.
A A Pract. 2018 Jun 15;10(12):338-339. doi: 10.1213/XAA.0000000000000716.
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.
我们报告了一例恶病质且患有腹主动脉瘤的患者，因大肠梗阻行急诊剖腹探查术后，在麻醉恢复过程中出现持续性术后截瘫。术后颈椎、胸椎和腰椎磁共振成像仅显示颈椎管狭窄。我们推测，术中对动脉粥样硬化主动脉的操作可能导致术中栓塞，以及术中短暂的低血压导致脊髓缺血。本报告强调了维持术中血流动力学稳定以及谨慎处理腹主动脉的重要性，尤其是在体重不足且患有腹主动脉瘤的患者中。
