Int J Thyroidol.  2015 Nov;8(2):187-189. 10.11106/ijt.2015.8.2.187.

Life-Threatening Upper Airway Obstruction Caused by Delayed Hematoma Occurring 8 Days Post-Thyroidectomy

• Ryu KA
• Seo ST
• Rha KS
• Koo BS

• KMID: 2171227
• DOI: http://doi.org/10.11106/ijt.2015.8.2.187

Abstract

Due to modern methods, thyroid surgery is generally considered quite safe. However, post-thyroidectomy hematomas, although rare, can be life-threatening and unpredictable complications of thyroid surgery. Most postthyroidectomy hematomas occur within 24 hours of surgery, with delayed hematomas occurring after one post-operative week being exceedingly rare. Herein, we report a case of delayed post-thyroidectomy hematoma with respiratory distress occurring on the eighth post-operative day in a patient who was not taking anticoagulants and had no hematologic diseases. Although most bleeding occurs within 24 hours, caution should be used even in such patients who are considered low-risk.

Keyword

Thyroidectomy; Hematoma; Postoperative complication

MeSH Terms

Airway Obstruction*
Anticoagulants
Hematologic Diseases
Hematoma*
Hemorrhage
Humans
Postoperative Complications
Thyroid Gland
Thyroidectomy
Anticoagulants

Figure

• 

  Fig. 1. Neck angio-computed tomography (CT) scan of our patient. It showed a low-attenuating lesion with partial rim enhancement, suggesting a hematoma in the thyroidectomy bed.

Reference

References

1. Savargaonkar AP. Post-thyroidectomy haematoma causing total airway obstruction-a case report. Indian J Anaesth. 2004; 48(6):483–5.

2. Rosenbaum MA, Haridas M, McHenry CR. Life-threatening neck hematoma complicating thyroid and parathyroid surgery. Am J Surg. 2008; 195(3):339–43. ; discussion 343.

3. Calo PG, Erdas E, Medas F, Pisano G, Barbarossa M, Pomata M, et al. Late bleeding after total thyroidectomy: report of two cases occurring 13 days after operation. Clin Med Insights Case Rep. 2013; 6:165–70.

4. Lee HS, Lee BJ, Kim SW, Cha YW, Choi YS, Park YH, et al. Patterns of post-thyroidectomy hemorrhage. Clin Exp Otorhinolaryngol. 2009; 2(2):72–7.

5. Abbas G, Dubner S, Heller KS. Reoperation for bleeding after thyroidectomy and parathyroidectomy. Head Neck. 2001; 23(7):544–6.

6. Calo PG, Pisano G, Piga G, Medas F, Tatti A, Donati M, et al. Postoperative hematomas after thyroid surgery. Incidence and risk factors in our experience. Ann Ital Chir. 2010; 81(5):343–7.

7. Burkey SH, van Heerden JA, Thompson GB, Grant CS, Schleck CD, Farley DR. Reexploration for symptomatic hematomas after cervical exploration. Surgery. 2001; 130(6):914–20.

8. Defechereux T, Hamoir E, Nguyen Dang D, Meurisse M. Drainage in thyroid surgery. Is it always a must? Ann Chir. 1997; 51(6):647–52. ; discussion 653.

9. Khanna J, Mohil RS, Chintamani , Bhatnagar D, Mittal MK, Sahoo M, et al. Is the routine drainage after surgery for thyroid necessary? A prospective randomized clinical study [ISRCTN-63623153]. BMC Surg. 2005; 5:11.

10. Schoretsanitis G, Melissas J, Sanidas E, Christodoulakis M, Vlachonikolis JG, Tsiftsis DD. Does draining the neck affect morbidity following thyroid surgery? Am Surg. 1998; 64(8):778–80.

11. Hurtado-Lopez LM, Lopez-Romero S, Rizzo-Fuentes C, Zaldivar-Ramirez FR, Cervantes-Sanchez C. Selective use of drains in thyroid surgery. Head Neck. 2001; 23(3):189–93.

12. Promberger R, Ott J, Kober F, Koppitsch C, Seemann R, Freissmuth M, et al. Risk factors for postoperative bleeding after thyroid surgery. Br J Surg. 2012; 99(3):373–9.