Introduction and importance: Anterior cervical discectomy and fusion (ACDF) is a regular surgical procedure for correcting spinal deformities and pain relief. There are several rare complications of ACDF, one of which is postoperative hematomas. Here, we report an unexpected case of intra-abdominal hematoma after ACDF with no prior abdominal symptoms or underlying conditions identified since admission. This report will describe the events and interventions that took place for this patient.
Case description: The patient is a 44-year-old female with a history of neck pain of four-month duration. On Magnetic Resonance Imaging (MRI), a degenerative cervical disk (C5-C6) was identified. Prior surgical history is significant for a C4-C5 ACDF 3 years ago. An anterior cervical discectomy and fusion was performed and the patient was doing well relatively post-surgery. However, in less than 24 h, the patient complained of severe abdominal pain. An abdominal Computerized topography angiogram (CTA) scan revealed internal bleeding and a splenic aneurysm rupture. The patient immediately underwent an urgent laparotomy and splenectomy.
Clinical discussion: Splenic artery aneurysm incidence is rare and is detected incidentally by imaging technology in asymptomatic patients or upon rupture. Splenic artery aneurysm rupture can be spontaneous and unpredictable in previously undiagnosed patients leading to life-threatening symptoms of intra-abdominal hemorrhage.
Conclusion: Patients undergoing ACDF should be monitored closely following surgery for any complications. Physicians should consider the possibility of any signs of hematoma due to underlying conditions that are undiagnosed in order to treat accordingly.
Keywords: ACDF; Aneurysm rupture; Anterior cervical spinal surgery; Splenectomy.
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