Intestinal necrosis secondary to vertebroplasty-related cement embolization: a case report with a favorable outcome

Bone cement leakage is a recognized complication of percutaneous vertebroplasty (PVP), whereas arterial cement embolization causing acute mesenteric ischemia is exceptionally rare. We report a case of intestinal necrosis secondary to superior mesenteric artery embolization following PVP. A 65-year-old woman underwent PVP for a T12 vertebral compression fracture and developed abdominal discomfort during the procedure, followed by severe, progressive abdominal pain approximately 10 hours later. Computed tomography angiography revealed cement migration into the abdominal aorta and its visceral branches, resulting in superior mesenteric artery embolization with extensive bowel ischemia, accompanied by renal and splenic infarctions. Emergency laparotomy confirmed massive small-bowel necrosis requiring bowel resection and jejunocolic anastomosis. Residual arterial cement emboli were managed nonoperatively. The patient recovered with postoperative nutritional support and dietary management and was discharged 3 weeks after surgery. Arterial cement embolization is a rare but potentially fatal complication of vertebroplasty. Early CTA evaluation, prompt surgical intervention, and multidisciplinary management are essential for improving outcomes in patients presenting with acute abdominal pain after vertebral augmentation.