Clin Exp Otorhinolaryngol.  2009 Jun;2(2):72-77. 10.3342/ceo.2009.2.2.72.

Patterns of Post-thyroidectomy Hemorrhage

• Lee HS
• Lee BJ
• Kim SW
• Cha YW
• Choi YS
• Park YH
• Lee KD

• KMID: 2007188
• DOI: http://doi.org/10.3342/ceo.2009.2.2.72

Abstract

OBJECTIVES
Postoperative hemorrhage is a potentially life-threatening complication in thyroid surgery. This study was performed to review the clinical patterns of post-thyroidectomy hemorrhage, and especially as they are related to the source of bleeding.
METHODS
We performed a retrospective review of 10 patients (0.96%) with post-thyroidectomy hemorrhage that required surgical evacuation. The clinical patterns such as the time interval from surgery to hemorrhage and the signs and symptoms according to the bleeding focus were evaluated.
RESULTS
The mean time interval from surgery to symptom onset was 7 hr 52 min. Six cases showed bleeding deep to the strap muscles, while the other 4 cases showed bleeding superficial to the muscles. Ecchymosis was prominent and dark in color in 3 of the 4 cases (75%) of superficial bleeding, however it was identified in only 2 of the 6 cases (33%) of deep bleeding. Respiratory distress occurred in two cases of hematoma deep to the strap muscles, but in none of the cases with superficial bleeding.
CONCLUSION
The post-thyroidectomy hemorrhage had some different clinical patterns between the superficial cases and the deep cases, showing that life-threatening airway obstruction occurred from the deep hematoma. A thorough understanding of the clinical patterns of post-thyroidectomy hemorrhage between the cases of superficial and those cases of deep hematoma may provide valuable surgical tips to manage this potentially lethal complication.

Keyword

Thyroidecotmy; Hemorrhage; Complication

MeSH Terms

Airway Obstruction
Ecchymosis
Hematoma
Hemorrhage
Humans
Muscles
Postoperative Hemorrhage
Retrospective Studies
Thyroid Gland

Figure

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  Fig. 1 Superficial hematoma. (A) Hematoma superficial to the strap muscles and prominent ecchymosis were identified. (B) Hematoma deep to the strap muscles was not detected.

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  Fig. 2 Deep hematoma. (A) A significant amount of hematoma superficial to the strap muscles was not identified. The extent of the ecchymosis was smaller and the degree of skin discoloration was less, compared to those of cases of the superficial hematoma. (B) Hematoma deep to the strap muscles was identified.

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