Abstract
Introduction: Post-thyroidectomy neck hematoma is one of the most feared and dangerous complications in thyroid surgery leading to airway obstruction and, if diagnosed and treated too late, fatal outcome may result. For prevention most crucial is effective intraoperative hemostasis. Additionally the patient should avoid physical strain. In case of post-thyroidectomy acute bleeding immediate airway protection is essential. Sometimes even bedside evacuation of hematoma is live saving. Neck hematoma more than 24 hours after thyroid surgery, as in our case, is rare. Case Report: In a 56-year old female, 10 days after hemithyroidectomy and ipsilateral parathyroidectomy on the right side a post surgical neck hematoma arose. At that time the patient stayed in our region on holiday for skiing in a mountain skiresort about 100 km away from our clinic. Emergency doctor on site did not intubate her and took her to our medical university hospital, although the next hospital would have been 25 km closer. On arrival the patient was already hard breathing, unable to speak and swallow. Immediate intubation via videolaryngoscopy by an experienced senior anaesthesiologist succeeded. Due to major edema of the upper airway the patient had to be remained intubated for 3 days after reoperation. Seven days after the event the patient could be discharged from hospital. Conclusion: Post-thyroidectomy neck hematoma more than 24 hours after surgery is rare. Misinterpretation of the life-threatening situation may lead to major complications as apallic syndrome or even death. Immediate protection of the airway by intubation is essential.
Highlights
Post-thyroidectomy neck hematoma is one of the most feared and dangerous complications Accepted: April 14, 2018 in thyroid surgery leading to airway obstruction and, if diagnosed and treated too late, result
Neck hematoma more than 24 hours after thyroid surgery, as in our case, is rare
Post-thyroidectomy neck hematoma more than 24 hours after surgery is rare
Summary
Post-thyroidectomy neck hematoma belongs to the most dangerous complications in thyroid surgery. About 2 hours later she awoke again, the tightness in her throat was much more intense, breathing and swallowing became harder She noticed a swelling of the neck and emergency doctor was called. Hematoma without swelling on the rear of the throat and severe hematoma of the vocal cords was found The patient stayed another day under observation at the intensive care unit. On the day clinical status improved and she was transfered again to normal ward Another laryngoscopic control showed partial remission of the hematoma of the vocal cords. Laryngoscopy before extubation: reduced swelling in the area of the supraglottis, epiglottis and the aryepiglottic plication to the arytenoid hematoma without swelling on the rear of the throat severe hematoma of the vocal cords. →removal of the tracheal tubus transfer to intermediate care unit transfer to ward laryngoscopic control: partial remission of the hematoma of the vocal cords discharged from hospital
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