DELICATE OP

In a surgery of nerves, docs hold theirs and save life

DurgeshNandan.Jha@timesgroup.com

New Delhi:09.09.2018

A quick fix measure adopted by doctors at AIIMS saved the life of a woman who suffered damage to a major blood vessel during spine surgery. As well as being recognized as a novel treatment by the British Medical Journal, the technique used could prove valuable in dealing with similar cases in the future.

The details of the medical thriller were published by the reputed journal in its latest issue. The case involved a 42-yearold woman who had a prolapsed disc in the lower spine due to which she could not sit or lie down comfortably. Her son, a doctor, decided get his mother operated on at AIIMS trauma centre.

The woman, whose identity has been withheld, was hypertensive, though her blood pressure was under control through medication. The procedure for relieving the pressure the prolapsed disc was placing on some nerves was progressing well when the patient suddenly exhibited very low blood pressure (60/40mm Hg).

Surgery was abandoned and medicines injected to stabilize her. The operating surgeons, however, struggled to discover the reason for the drop inblood pressure. The presence of blood showed up in a scan and the doctors realized that during the operations, the common iliac artery (CIA), a major blood vessel, had been punctured. Two veins bringing back blood to the pelvic region were also damaged.

Despite all measures to resuscitate the women, she kept sinking, and before the medical team could decide the next step, she suffered a cardiac arrest. The patient would have died in a few minutes were it not for the timely intervention of a surgeon on duty who decided give her open-heart massage by cutting open the chest cavity and manually pressing the heart instead of cardio-pulmonary resuscitation, as usual. After 15 minutes of manual massage, the patient miraculously revived. Once her blood started circulating, the doctors identified the site of the blood leakage.

However, this was only a minor win in the gigantic crisis at hand. Injury and haemorrhaging require urgent recognition and appropriate surgical management.

So, in a quick-fix, now termed novel by the British Medical Journal, Mishra’s team repaired the CIA by transposing a segment of the internal iliac artery, which supplies blood to the pelvic regions and legs. “The technique is simple, reliable and fast and may prove valuable in dealing with such injuries,” the BMJ noted.