Abstract
AbstractThis is the first report of a segmental mediolysis occurring in arterioles, affecting the neck/tonsillar region and leading to a fatal hemorrhage after a tonsillectomy in a 20-year-old woman. Arteriolar mediolysis could be observed in tissue layers about 2 cm distant from the tonsillectomy region. Reparative changes were observed in the carotid and small neck arteries as well as in only one intramyocardial arteriole; however, no other vascular regions typically reported in segmental mediolysis arteriopathy were affected and aneurysm formation was not observed. No family history of vascular disease or hypertension was known. Pathophysiologically, previously reported reasons for post-tonsillectomy bleeding could be excluded. Segmental mediolysis may represent a wider spectrum of affected arteriolar vessels besides the reported small and medium sized arteries leading to aneurysms, which impedes radiographic diagnosis.
Highlights
Fatal hemorrhage after tonsillectomy remains a rare but important complication
Extensive intensive care measures revealed that the remaining lung tissue was significantly more fluid-rich and blood-rich
Arterial vessels in other organs/ organ systems such as the abdomen, kidneys, liver, coronary and cerebral arteries and all veins investigated did not reveal any aneurysm expected in mediolysis or similar pathology as described
Summary
Fatal hemorrhage after tonsillectomy remains a rare but important complication. It has been attributed to a variety of pathophysiological causes, among them congenital malformations, genetic defects, infectious diseases as well as technical reasons Segmental mediolytic arteriopathy (SMA) is a rare condition. It was first defined in 1976 by Slavin et al [12] and has been well described in the literature, to date the etiology of the condition is unknown. This article reports an unusual case of fatal bleeding after a bilateral tonsillectomy that was at least partly caused by SMA affecting arterioles only in the neck region in a 20-year-old woman. After admission to the emergency room, transoral hemostasis was started because of diffuse bleeding from the right palatine tonsil area without a clearly visible source. Figure shows details of arteriole with mediolysis by vacuolization of medial muscle cells (black arrows), while the endothelial layer is intact; no thrombi or inflammation are present.Masson staining; bar 100 ÎĽm.
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