Bilateral Otorrhagia after Robotically Assisted Gynecologic Surgery in the Setting of a Reduced Trendelenburg Position and Low-Pressure Pneumoperitoneum: A Case Report and Review of the Literature

Abstract

Perioperative otorrhagia in association with non-otolaryngologic surgery is rare. The cause is typically attributed to the physiologic derangements associated with the Trendelenburg position and pneumoperitoneum during laparoscopic surgery. The most well-accepted etiology is an increase in arterial and venous pressures causing the rupture of subcutaneous capillaries, although the exact etiology remains unclear. We present the first reported case of bilateral spontaneous otorrhagia associated with robotically assisted laparoscopic surgery involving a reduced Trendelenburg position and low-pressure pneumoperitoneum. Perioperative hypertension, female gender, advanced age, and increased bleeding risk may contribute to the development of this rare complication.

Bilateral external auditory canal masses following repair of ruptured abdominal aortic aneurysm and open decompressive exploratory laparotomy for compartment syndrome: A rare case of spontaneous bilateral otorrhagia

“…Administration of drugs or factors that may increase the risk of bleeding complications were implicated as well. Our patient's intraoperative INR was 2.51 and may have contributed to the spontaneous otorrhagia [1] .…”

“…Seven of 10 patients in prior reports were over the age of 59. Our patient was 60 years old [1] . Administration of drugs or factors that may increase the risk of bleeding complications were implicated as well.…”

Factors related to clearance of the small pelvic cavity during gynecologic laparoscopic surgery

“…Removing the small intestine from the pelvic cavity is important to obtain a clear view and to avoid inadvertent contact with the intestine during surgery. However, the steep Trendelenburg position has been reported to be associated with complications such as gas embolism, 1 increased intraocular pressure, [2][3][4] increased intracranial pressure, 5,6 decreased blood flow in the internal carotid artery, 7 spontaneous otorrhea, 8 upper-body complications, 9 nerve injury, 10,11 peripheral neuropathy, 12 venous thromboembolism, 13,14 and lower-extremity compartment syndrome caused by impaired blood flow. 15 Gould et al previously reported that a mean Trendelenburg angle of 28.0 was required to complete robotic gynecologic surgery.…”