Total thyroidectomy followed by bilateral pneumothorax and pneumomediastinum with simultaneous damage to the recurrent l
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Hellenic Journal of Surgery (2014) 86:6, 375-378
Total Thyroidectomy Followed by Bilateral Pneumothorax and Pneumomediastinum with Simultaneous Damage to the Recurrent Laryngeal Nerve: Report of a Case C. Oikonomou, S. Aloizos, P. Aravosita, C. Mystakelli, E. Kanna, S. Gourgiotis
Abstract Background: Thyroidectomy is a common and safe surgical procedure which is typically associated with low morbid-
ity. Pneumomediastinum and pneumothorax following cervical emphysema after thyroidectomy have been rarely mentioned, and the mechanism implicated in these two conditions is uncertain. Case report: We present a 53-year-old male who experienced extensive emphysema, bilateral pneumothorax and
pneumomediastinum following total thyroidectomy under general anaesthesia with damage to the left recurrent laryngeal nerve. The diagnostic evaluation, management, and the possible aetiology of these complications are discussed. Results: We believe that the pneumothorax was not the result of the damage to the airway or larynx. We assume that
the pneumothorax was caused by operative damage to the neck or was due to anatomical reasons. It is also feasible that air entered through the thinned fascial layer owing to the surgery. Another hypothesis is the possibility that the pneumothorax was caused by mid-surgery damage, given the difficulties in surgical manoeuvering. This hypothesis is further reinforced when considering the synchronous damage to the left recurrent laryngeal nerve. Conclusion: The complications observed in this case after total thyroidectomy with invasive manoeuvres were very
rare. However, they were suspected early and the patient recovered without further problems. Key words Thyroidectomy; bilateral; pneumothorax; pneumomediastinum; laryngeal nerve
Introduction Thyroidectomy is a common and safe surgical procedure which is typically associated with low morbidity, providing the parathyroid glands and laryngeal nerves are identified and preserved and the surgeon is watchful as to the major issue of haemorrhage. The complications of thyroidectomy are well known and described, some of which can be fatal; others are quite disturbing, particularly in their permanent form.
C. Oikonomou MD, S. Gourgiotis MD PhD First Surgical Department, 417 NIMTS Military Veterans’ Fund Hospital of Athens, Greece S. Aloizos MD PhD, P. Aravosita MD, C. Mystakelli MD, E. Kanna MD Intensive Care Unit, “Mitera” Obstetric & Gynaecologic Hospital, Athens, Greece Corresponding author: Stavros Gourgiotis MD PhD 41 Zakinthinou Street, 15669, Papagou, Athens, Greece Tel. & fax: +30 210 6998362 e-mail: [email protected] Received 12 July 2014; Accepted 27 Sept 2014
Hellenic Journal of Surgery 86
Pneumomediastinum and pneumothorax occur in patients with increased intra-alveolar pressure (Valsalva manoeuvre, cough and emesis) which leads to the rupture of marginal pulmonary alveoli [1]. It is a complication that can arise during general anaesthesia, mid- or post-surgery. However, pneumomediastinum and pneumothorax following cervical emphysema a
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