Hematuria during Lumbar Spine Surgery in Prone Position: A Perioperative Challenge

Background: Hematuria in patients undergoing surgery in prone position is a perioperative diagnostic challenge, making it difficult to find the source of bleeding in this position. Gross hematuria during this period adds to the surgical blood loss, contributing to morbidity, and mortality. We present a case of intraoperative hematuria during lumbar spine surgery in prone position which was investigated postoperatively.

Case Description: A 35-year-old female patient of ASA class 1 suffered a fall from fourth floor of construction building with impact on her feet. Radiological assessment at the time of admission revealed L1 burst fracture. Transforaminal lumbar fixation was planned on fourth day following injury. Patient was induced and positioned prone. Thirty minutes after commencement of surgery, sudden onset of frank hematuria was noted which continued over 10 minutes, amounting to approximately 400 mL. Surgery was stopped. Following urosurgical consultation, catheter was flushed with 250 mL of saline. After flushing, frank hematuria subsided; however, blood tinged urine continued to drain in the postoperative period. Urosurgical workup was done postoperatively. USG KUB was inconclusive. CT urogram was done, revealing retroperitoneal hematoma extending up to right psoas muscle; right perirenal hematoma with renal contusion and clots in urinary bladder. Patient was managed conservatively.

Conclusion: Spine injury, renal injury and retroperitoneal hematoma are common occurrence following vertical deceleration injury due to fall from height. High index of suspicion must be maintained even if initial imaging misses these injuries. Intraoperative hematuria in this case was due to dislodgement of clots in kidney, following prone positioning.

Publication History

Article published online:
25 March 2020