Prolonged brachial plexus neuropathy: a rare complication following protracted endometriosis surgery in Lloyd-Davies position

Anna Katrina Hay, Anna McDougall, Peter Hinstridge, Sanjeev Rajakuldendran, Wai Yoong
BMJ case reports · 2021 · vol. 14(11) , pp. e243408 · doi:10.1136/bcr-2021-243408 · PMID:34844958 · PMC8634370 · W3217524815
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Abstract

Brachial plexus injury is a rare but potentially serious complication of laparoscopic surgery. Loss of motor and/or sensory innervation can have a significant impact on the patient's quality of life following otherwise successful surgery. A 38-year-old underwent elective laparoscopic management of severe endometriosis during which she was placed in steep head-down tilt Lloyd-Davies position for a prolonged period. On awakening from anaesthesia, the patient had no sensation or movement of her dominant right arm. A total plexus brachialis injury was suspected. As advised by a neurologist, an MRI brachial plexus, nerve conduction study and electromyography were requested. She was managed conservatively and made a gradual recovery with a degree of residual musculocutaneous nerve neuropathy. The incidence of brachial plexus injury following laparoscopy is unknown but the brachial plexus is particularly susceptible to injury as a result of patient positioning and prolonged operative time. Patient positioning in relation to applied clinical anatomy is explored and risk reduction strategies described.

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endometriosis

MeSH descriptors

Brachial Plexus Brachial Plexus Neuropathies Brachial Plexus Neuropathies Endometriosis Endometriosis Adult Female Humans Musculocutaneous Nerve Quality of Life

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