Urgent thoracotomy for thoracic hemorrhage after posterior correction surgery in adolescent idiopathic scoliosis: case report and literature review

Posterior correction surgery for adolescent idiopathic scoliosis (AIS) carries a risk of rare, life-threatening complications. We present a case of massive tension hemothorax following AIS surgery, highlighting the diagnosis and management challenges. A 14-year-old girl with AIS (82° thoracic curve) underwent posterior correction and fusion surgery from T3 to L1. Intraoperative bleeding was approximately 800 ml. Shortly after extubation, the patient developed acute respiratory distress and hypotension. Examination and chest radiography confirmed a left-sided tension hemothorax. An emergent thoracentesis drained about 5000 ml of blood. Angiography failed to identify the bleeding source, necessitating urgent thoracotomy. The bleeding site, located at the 3rd left intercostal space, was successfully controlled via endoscopic cauterization. This case underscores that tension hemothorax, though rare, requires high clinical suspicion. Unexplained hypotension during or after AIS correction surgery should prompt immediate investigation. When minimally invasive intervention fails, urgent exploration is essential and can be life-saving.