Traumatic dislocation of L4 vertebra, associated with perforation of small intestine and dissection of infrarenal aorta: a case report and review of literature
Abstract
Background: A section of the spine most often affected by trauma is located between the T10 and L2 segments. In this paper, we present a patient who suffered injury
at the l4–l5 level, as well as dissection of the infrarenal aorta and perforation of the small intestine.
Case study: A 39-year-old woman was injured in a car accident as a passenger, restrained by a seat belt. After resuscitation and diagnostic procedures, the injuries were treated in three stages. First, explorative laparotomy, resection, and T-T anastomosis of the small intestine were done. Repair of infrarenal aorta dissection with the CERAB technique followed. Finally, open reduction and stabilization of the lumbar spine, with exploration of the spinal canal and repair of the dural sac, were performed. In the postoperative period, normal function of the gastrointestinal tract, normal blood flow in the lower extremities, and normal alignment of the lumbar spine were restored, associated with partial recovery in the neurological status of the lower extremities.
Conclusion: The possibility of abdominal aortic rupture associated with lumbar spine fracture should always be considered in blunt force trauma. Endovascular stentgraft
repair techniques, including the CERAB method, are a valid method for treating these patients. Vascular repair needs to be followed by early spinal stabilization to further diminish mortality and complications rate.
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