LAUSR

BACKGROUND Posterior decompression & fusion surgery is one of commonest performed surgery for thoracolumbar tuberculosis with destruction of vertebral bodies. Tuberculosis causes gross destruction of the vertebral bodies and surrounding tissue, making them friable. CASE DESCRIPTION We present an unusual but dreaded complication which we encountered during posterior decompression and instrumentation surgery in a 65-year-old female with T10-T11 tuberculosis of spine. During the surgical exposure while reflecting posterior paraspinal muscles on left side, there was accidental slip of Cobb elevator around transverse process to the extent of two third of its length on left side anteriorly. The instrument was immediately withdrawn. There was no active bleeding in the field. Rest of the surgery was uneventful. In postoperative period, however, patient developed severe abdominal pain with abdominal distention. General surgery opinion was immediately taken and the patient was immediately investigated in the form of a CT scan. It was found that there was a traumatic laceration of pancreas. Patient underwent emergency exploratory laparotomy & repair of pancreatic laceration. The patient required intensive monitoring and ICU stay and ultimately went on to recover fully over the next few weeks. CONCLUSION This case illustrates that possibility of pancreatic injury should always be kept in mind if patient develops acute abdominal discomfort in post-operative period. Also, a multidisciplinary approach along with intensive care back-up and vigilant post-operative monitoring are of utmost importance, especially when an unusual event has occurred during the surgery.