Severe retroperitoneal hemorrhage complicating anterior iliac bone graft acquisition

Abstract

The anterior iliac crest is a frequent donor site for procuring autologous bone grafts for reconstructive surgical procedures. 1 Complications following this procedure are rare and usually minor. Pain, infection, and self-limited hematoma are most commonly reported. 2 More significant complications include stress fracture of the iliac bone, 1–3 herniation of abdominal viscera through the donor site bone defect, 4,5 ilioinguinal or femoral neuropathy, 6 ureteral injury, arteriovenous fistula, 7 and meralgia paresthetica (anesthesia and dyesthesia in the region supplied by the lateral femoral cutaneous nerve). 8 Recently, a patient at our institution developed massive, subacute retroperitoneal hemorrhage following acquisition of an anterior iliac crest bone graft for anterior cervical spine fusion. Further complications related to the hemorrhage ultimately led to the patient's death. To our knowledge, no similar case has been reported in the literature. Awareness of this rare, but potentially catastrophic, complication of iliac bone graft acquisition is important for proper postoperative management, especially when unexplained postoperative hypotension or decreasing hematocrit are encountered.