Multiple Rare Complications Following Total Thyroidectomy and Bilateral Neck Dissection: Case Report and Literature Review

Abstract

Background: Thyroidectomy is a common and safe surgical procedure and is typically associated with low morbidity and mortality. Delayed tracheal rupture after thyroidectomy has only infrequently been reported. Here we are reporting a case in which a number of rare complications of total thyroidectomy and neck dissection happened over a very short period of time with a review of existing literature. Case presentation: A 48-year-old man, diagnosed as metastatic papillary thyroid cancer. Underwent total thyroidectomy and bilateral modified neck dissection complicated by severe bronchospasm, bilateral pneumothorax, pneumomediastinum, pneumopericardium managed by underwater seal drainage of his chest cavities. On the 10th postoperative day he developed spontaneous tracheal rupture which compromised his airway. He was coded, eventually intubated resuscitated. In the operating room he had his neck explored, neck haematoma evacuated, tracheal tear debrided and a tracheostomy tube was inserted. Conclusion: Thyroidectomy remain a commonly performed safe surgery typically associated with low mortality and morbidity. However other rare and serious complications as observed in this case can sometimes take place and can be life threatening. Bilateral pneumothorax, pneumomediastinum and pneumopericardium are examples of such serious complications. Multiple contributing factors include heavy smoking, alleged barotrauma, and extensive electrocautery dissection. In our case the late spontaneous rupture of the trachea most likely been predisposed to by the excessive explosive smokers cough.