TITLE:
Unexpected Postoperative Paraplegia after Thoracotomy in Lung Cancer: Incidental Migration of Oxidized Regenerated Cellulose Used for Hemostasis of Intercostal Space Bleeding
AUTHORS:
Takanori Ayabe, Masaki Tomita, Shigeko Shimizu, Etsuko Yokoyama, Manabu Okumura, Koichiro Itai, Kunihide Nakamura
KEYWORDS:
Lung Cancer, Incident, Oxidized Regenerated Cellulose, Migration, Thoracotomy, Intercostal Space Bleeding, Paraplegia
JOURNAL NAME:
Surgical Science,
Vol.8 No.8,
August
23,
2017
ABSTRACT: Background: We experienced a very rare complication, that is, an unexpected postoperative paraplegia due to the incidental migration of oxidized regenerated cellulose used for hemostasis of intercostal space bleeding. Patients and Methods: The objective is to analyze the cause and to take measures against the very rare complication from an empirical analysis and the literature. For a 78-year-old male with suspected lung cancer in the right upper lobe (S1), a thoracotomy was performed. For hemostasis of the bleeding from the 5th intercostal thoracotomy space, we used and placed oxidized regenerated cellulose at the continuous oozing bleeding sites. On the 3rd postoperative day, paralysis beneath thoracic vertebrae level 6 was observed. Immediate computed-tomographic (CT) scanning and magnetic resonance imaging (MRI) displayed a 17 × 9 × 14 mm epidural hematoma in the spinal canal at level 5 of the thoracic vertebrae. An emergent laminectomy for the thoracic vertebra was performed to remove the oxidative cellulose and haematoma, and the compression was released. The paraplegia gradually began to recover and maintain a standing position. After 1 year from the event, the patient can walk by himself with a crutch. Results: The causes were that the oxidative cellulose materials were used for the intercostal bleeding at the open thoracotomy. The migration of the oxidative cellulose materials into the epidural space and into thoracic spinal canal through the intervertebral foramen, or gradual penetration of the oxidative cellulose materials into the spinal canal due to respiratory costal movement. As a measurement of prevention, the hemostat materials should be completely removed after finishing of the hemostasis. In the case of a difficult hemostasis, consultation of an orthopedist or neurosurgeon to perform the appropriate hemostasis in good cooperation is required. Conclusion: If postoperative paraplegia is suspected, immediate CT scanning and/or MRI examination would become powerful diagnostic procedures as soon as possible to start an interventional treatment.