Prone Position-Induced Visceral Organ Injury During Spinal Surgery for Idiopathic Scoliosis: A Case Report of Hepatic, Pancreatic, and Renal Complication.

Intra-abdominal complications related to spinal surgery are uncommon but may result in serious morbidity. Prone positioning, often used in scoliosis correction procedures, has been implicated in compression-induced injuries of visceral organs, particularly in patients with anatomical deformities such as thoracic asymmetry and lumbar lordosis. We report a rare case of concurrent liver injury, pancreatic damage, and renal dysfunction following posterior spinal fusion in a 12-year-old male with idiopathic scoliosis. Despite intraoperative decompression precautions and stable hemodynamics, the patient developed acute abdominal symptoms and elevated hepatic, pancreatic enzymes, and creatinine indicating renal damage on postoperative day 1. Imaging revealed a liver contusion, ascites, and reduced enhancement of the left kidney, suggestive of organ compression. Renal findings were attributed to venous congestion likely caused by compression of the left renal vein between the aorta and the superior mesenteric artery, resembling nutcracker syndrome. Conservative management led to rapid clinical improvement, with full recovery observed by postoperative day 18. This case highlights the importance of recognizing position-related organ injury during scoliosis surgery. Awareness of risk factors-including low body mass index and skeletal deformities-and early assessment of blood flow are essential for accurate diagnosis and appropriate management. Preoperative simulation of prone positioning may help mitigate the risk in anatomically vulnerable patients.