Rare documented case report of a retroperitoneal hernia as a complication to an anterior retroperitoneal spinal exposure

INTRODUCTION: Anterior retroperitoneal spinal exposures are widely used today for spinal surgeries. Incisional hernias are a documented complication of anterior spine exposures; however, there are no documented cases of hernias into the dissected retroperitoneal space. We presented this exceptionally rare patient's complication to underscores the critical importance of preserving the peritoneum as a biologic barrier during retroperitoneal spine exposures. PRESENTATION OF CASE: An obese 54 year-old female with a history of two recurrent small bowel obstructions treated conservatively after a retroperitoneal spinal exposure presented with another small bowel obstruction. The patient was taken to the operating room for exploratory laparotomy. Intraoperatively, the patient was found to have multiple loops of small bowel herniated through a small defect in the peritoneum. The small bowel was severely adherent to the retroperitoneum, resulting in torsion and obstruction. DISCUSSION: Based on intraoperative findings, we feel that the retroperitoneal hernia was directly related to the anterior lumbar spine exposure, in which peritoneal disruption is a well-reported phenomenon. There was mention of a peritoneal defect noted during the spine exposure procedure, with attempts to primarily close the defect. CONCLUSION: While disruption of the peritoneum occurs not infrequently during these primarily retroperitoneal procedures, this case should serve as a cautionary tale and reinforce the need for identification and immediate repair of any peritoneal defects that may be created during this type of procedure.