ABSTRACT
An 80-year-old woman without any previous otological symptoms underwent laparoscopic abdominoperineal resection for T3N0M0 low rectal carcinoma 4-5 cm from the anal verge. The total operative time was 6 h, of which she spent long hours in the Trendelenburg (35°) position due to difficult pelvic dissection. Midway through the procedure, she developed spontaneous non-traumatic bilateral otorrhagia. This case highlights the potential risk of increased intracranial pressure during prolonged periods of being in a steep Trendelenburg position caused either by the position itself or in combination with carbon dioxide pneumoperitoneum. We also consider the effect of a sudden change from this position to supine as a potential risk.
Subject(s)
Anal Canal/surgery , Digestive System Surgical Procedures/adverse effects , Head-Down Tilt/adverse effects , Hemorrhage/etiology , Intraoperative Complications , Pneumoperitoneum, Artificial/adverse effects , Tympanic Membrane/pathology , Abdomen/surgery , Aged, 80 and over , Digestive System Surgical Procedures/methods , Female , Humans , Laparoscopy/adverse effects , Laparoscopy/methods , Operative Time , Pelvis/surgery , Perineum/surgery , Pressure , Rectal Neoplasms/surgery , Rectum/pathology , Rectum/surgeryABSTRACT
Metastasis of primary endometrial adenocarcinoma to unusual sites has been occasionally reported. However, the authors believe this to be the first case report of metastasis to the appendix. This occurred more than 10 years after curative resection, and presented as sepsis with an intra-abdominal focus.
