Bilateral ischaemic optic neuropathy following laparoscopic proctocolectomy: a case report

Perioperative visual loss occurring during non-ocular surgery is a devastating event. Ischaemic optic neuropathy (ION) is a complication described following many procedures. We report the first case of ION occurring during laparoscopic proctocolectomy and discuss the aetiological factors. A 58-year-...

Full description

Saved in:
Bibliographic Details
Published in:Annals of the Royal College of Surgeons of England 2011-07, Vol.93 (5), p.e53-e54
Main Authors: Mizrahi, H, Hugkulstone, C E, Vyakarnam, P, Parker, M C
Format: Article
Language:English
Subjects:
Adenocarcinoma - surgery
Cancer surgery
Case reports
Colon
Humans
Hypotension - etiology
Intraoperative Complications - etiology
Laparoscopy
Male
Middle Aged
Online Case Report
Optic Neuropathy, Ischemic - etiology
Orbital Diseases - etiology
Postoperative Complications - etiology
Pressure
Proctocolectomy, Restorative - adverse effects
Prostate cancer
Sigmoid Neoplasms - surgery
Sigmoidoscopy - adverse effects
Urological surgery
Vision Disorders - etiology
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Perioperative visual loss occurring during non-ocular surgery is a devastating event. Ischaemic optic neuropathy (ION) is a complication described following many procedures. We report the first case of ION occurring during laparoscopic proctocolectomy and discuss the aetiological factors. A 58-year-old male presented with rectal bleeding and was diagnosed with an adenocarcinoma of the sigmoid colon. A very difficult laparoscopic sigmoidectomy and a low anterior resection of the rectum with an end colostomy were carried out. The technical difficulties were due to body habitus and the size and position of the tumour. The operation lasted over six hours. On the first day postoperatively, the patient complained of blurred vision. Examination showed that he had suffered bilateral ION. Despite the growing numbers of laparoscopic operations, ION has rarely been described. The cases that were published involved laparoscopic prostatectomy and a prolonged steep Trendelenburg position. We postulate that the patient presented here had suffered both from a relative hypotension and from an acute rise in the intraorbital pressure due to patient position, both factors combining to cause a disruption to ocular perfusion resulting in ION with severe permanent visual damage.
ISSN:0035-8843
1478-7083
DOI:10.1308/147870811X582828