Neal Matthew T, Curley Kara L, Richards Alexandra E, Kalani Maziyar A, Lyons Mark K, Davila Victor J
Departments of Neurologic Surgery and.
Vascular Surgery, Mayo Clinic, Phoenix, Arizona.
J Neurosurg Case Lessons. 2021 Jan 25;1(4):CASE20107. doi: 10.3171/CASE20107.
Anterior lumbar fusion procedures have many benefits and continue to grow in popularity. The technique has many potential approach- and procedure-related complications. Symptomatic retroperitoneal fluid collections are uncommon but potentially serious complications after anterior lumbar procedures. Collection types include hematomas, urinomas, chyloperitoneum, cerebrospinal fluid collections, and deep infections.
The authors present an unusual case of a patient with persistent symptoms related to a retroperitoneal collection over a 5-year period following anterior lumbar fusion surgery. To the authors' knowledge, no similar case with such extensive symptom duration has been described. The patient had an infected encapsulated fluid collection. The collection was presumed to be a postoperative lymphocele that was secondarily infected after serial percutaneous drainage procedures.
When retroperitoneal collections occur after anterior retroperitoneal approaches, clinical clues, such as timing of symptoms, hypotension, acute anemia, urinary tract infection, hydronephrosis, elevated serum creatinine and blood urea nitrogen, low-pressure headaches, anorexia, or systemic signs of infection, can help narrow the differential. Retroperitoneal collections may continue to be symptomatic many years after anterior lumbar surgery. The collections may become infected after serial percutaneous drainage or prolonged continuous drainage. Encapsulated, infected fluid collections typically require surgical debridement of the capsule and its contents.
腰椎前路融合手术有诸多益处，且其受欢迎程度持续上升。该技术存在许多与手术入路及操作相关的潜在并发症。有症状的腹膜后积液虽不常见，但却是腰椎前路手术后潜在的严重并发症。积液类型包括血肿、尿性囊肿、乳糜腹、脑脊液积聚及深部感染。
作者报告了一例不同寻常的病例，患者在腰椎前路融合手术后5年一直存在与腹膜后积液相关的症状。据作者所知，尚无类似症状持续时间如此之长的病例报道。该患者有一个感染性包裹性积液。该积液被推测为术后淋巴管囊肿，在多次经皮引流术后继发感染。
当腹膜后手术入路后出现腹膜后积液时，临床线索，如症状出现时间、低血压、急性贫血、尿路感染、肾积水、血清肌酐和血尿素氮升高、低压性头痛、厌食或全身感染迹象等，有助于缩小鉴别诊断范围。腰椎前路手术后多年，腹膜后积液可能仍有症状。经皮多次引流或长期持续引流后，积液可能会发生感染。包裹性感染性积液通常需要对囊壁及其内容物进行手术清创。
