Bilateral ischaemic optic neuropathy following laparoscopic proctocolectomy: a case report

• 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
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/147870811X582828

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.