Paraplegia after Gastrectomy in a Patient with Cervical Disc Herniation: A Case Report and Review of Literature

Paraplegia is a rare postoperative complication. We present a case of acute paraplegia after elective gastrectomy surgery because of cervical disc herniation. The 73-year-old man has the medical history of cervical spondylitis with only symptom of temporary pain in neck and shoulder. Although the patient’s neck was cautiously preserved by using the Discopo, an acute paraplegia emerged at about 10 hours after the operation. Severe compression of the spinal cord by herniation of the C4-C5 cervical disc was diagnosed and emergency surgical decompression was performed immediately. Unfortunately the patient showed limited improvement in neurologic deficits even after 11 months. 1. Introduction Paraplegia is a rare postoperative complication, and the pathology is various. We present a case of acute paraplegia after elective gastrectomy surgery because of cervical disc herniation. The IRB of Shanghai Sixth People’s Hospital reviewed the case report and gave permission for us to publish the report. 2. Case Description A 73-year-old man with peptic ulcer and bleeding was checked into the Department of Gastroenterology due to brown vomit and drain black stool once. The patient has a past medical history of duodenal ulcer for 18 years and complained from abdominal discomfort for 4 days. He received medical treatment with omepazole for 10 days and then was referred to the Department of General Surgery for selective gastrectomy. He denied any other medical history or other medication during preoperative visit by anesthetist. General anesthesia was induced by intravenous administration of 15？μg/kg fentanyl, 2？mg/kg propofol, and 0.1？mg/kg rocuronium. As the patient had loosened teeth, Discopo was taken for orotracheal intubation. During the whole process, the patient’s neck was placed in a neutral position. The patient was mechanically ventilated with the settings of FiO2 1.0, tidal volume 8？mL/kg, respiratory rate 10/min, and inspiration/expiration 1/2 and one minimum alveolar concentration of sevoflurane was administered during the surgery. In the meantime, propofol (2？mg/kg/h) and fentanyl (3？μg/kg/h) were also infused. Subtotal gastrectomy was performed, and gastrointestinal tract was reconstructed with the method of Billroth II. The operation, which lasted about 2 hours, was uneventful with a total blood loss of 250？mL. There was no hemodynamic instability during surgery. The patient was sent to the postoperative care unit (PACU) and extubated 30 minutes later. The recovery process was smooth, and the patient was transferred to surgery intensive care unit