Sequential pancreatitis and diverticulitis following elective anterior lumbar disc replacement: a case report of a rare postoperative domino effect.

Introduction: Anterior lumbar disc replacement (LDR) is a motion-preserving alternative to fusion for degenerative disc disease but carries risk of vascular and visceral injury. We report the first documented case of a sequential "domino effect" of acute postoperative pancreatitis followed by perforated diverticulitis after LDR surgery. Case presentation: A 66-year-old man with diabetes underwent elective L2-L3 LDR via a left anterior retroperitoneal approach. Although initially stable, he developed acute pancreatitis on postoperative day (POD) 1, confirmed by elevated enzymes and CT findings. Despite conservative treatment, recurrent fever and pain occurred, and by POD15, he developed peritonitis from perforated diverticulitis requiring open laparotomy and Hartmann colostomy. He recovered with multidisciplinary care. Clinical discussion: This case illustrates a possible "second-hit" mechanism where postoperative inflammatory stress triggered pancreatitis and subsequent colonic perforation. Conclusion: Postoperative abdominal pain following anterior lumbar surgery should not be dismissed as simple ileus. A high index of suspicion for rare but severe complications such as pancreatitis and diverticulitis, supported by early imaging, laboratory evaluation, and multidisciplinary team involvement, is essential. This case also advocates for selective preoperative abdominal CT in high-risk patients to aid surgical planning and mitigate catastrophic outcomes.