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European Spine Journal
Published in: European Spine Journal 9/2018

01-09-2018 | Grand Rounds

Pancreatic fracture: a rare complication following scoliosis surgery

Authors: Mélodie Juricic Jr., Kalitha Pinnagoda, Walid Lakhal, Jérome Sales De Gauzy, Olivier Abbo

Published in: European Spine Journal | Issue 9/2018

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Abstract

Study design

Grand Round case report.

Objective

We report a pancreatic fracture associated with Wirsung duct disruption, following a scoliosis surgery in a cerebral palsy adolescent.

Summary of background data

Spinal fusion surgery is the standard treatment for severe neuromuscular scoliosis. Many complications such as digestive ones account for its complexity. Postoperative acute pancreatitis is well described, although its pathophysiology remains unclear. To our knowledge, pancreatic fracture following scoliosis correction has never been described to date. Clinical presentation is not specific, and management is not consensual.

Case report

A 14-year-old adolescent had posterior spinal fusion for neuromuscular scoliosis due to cerebral palsy. During the postoperative course, she developed progressive nonspecific abdominal symptoms. The abdominal CT scan demonstrated a pancreatic fracture and a surgical exploration was decided as perforations of the bowel were highly suspected. Drains were placed around the pancreatic area as the retrogastric region was out of reach due to local inflammation. Conservative management led to the occurrence of a pseudocyst in the following weeks as the pancreatic leakage progressively dropped.

Discussion

Two hypotheses have been proposed: direct iatrogenic trauma from lumbar pedicle screws and pancreatic rupture related to the correction of the spinal deformity. As the latter seems the most likely, spinal surgeons should be aware of this occurrence following severe scoliosis correction.

Conclusion

Spinal fusion for severe neuromuscular scoliosis is a difficult procedure, with a high rate of complications. Among them, pancreatic fracture should be considered when abdominal pain persists in the postoperative period. Conservative management is advocated especially in case of a poor general condition.
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Metadata
Title
Pancreatic fracture: a rare complication following scoliosis surgery
Authors
Mélodie Juricic Jr.
Kalitha Pinnagoda
Walid Lakhal
Jérome Sales De Gauzy
Olivier Abbo
Publication date
01-09-2018
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 9/2018
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-017-5318-x

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