Missed Hemothorax After Posterior Correction Surgery for Pediatric Spinal Deformity

Öz

Background: Hemothorax represents a rare but serious complication after posterior correction surgery (PCS) for spinal deformities, occurring in roughly 0.1% of cases. When diagnosis is delayed or the condition is missed, the clinical consequences can be severe. In this retrospective review, we evaluated pediatric patients who developed hemothorax after PCS, aiming to describe the perioperative diagnostic difficulties and management experiences encountered. Methods: From 2016 to 2021, we retrospectively reviewed the records of 135 children who underwent posterior correction surgery for spinal deformity. Five of these patients were diagnosed with postoperative hemothorax and were included in the study. The variables assessed comprised demographic information, intraoperative imaging findings, the onset of hemodynamic deterioration, and the treatments applied. Results: The mean patient age at the time of surgery was 12.4 ± 2.9 years. Intraoperative posteroanterior chest radiographs were routinely obtained to confirm the placement of spinal instrumentation. A retrospective review of these films showed clear signs of hemothorax in four children and suspicious findings in one. None of the cases received intraoperative intervention for hemothorax. Because of subsequent hemodynamic instability, all five were transferred from the ward to the intensive care unit at different times after surgery. Chest tube drainage was required in three patients, thoracentesis in one, and surgical decortication in another. Conclusion: Early recognition of hemothorax plays a key role in preventing postoperative complications. For patients considered at higher risk, intraoperative bedside thoracic ultrasonography should be routinely employed. When this option is not accessible, performing a chest X-ray in the reverse Trendelenburg position before extubation may help reduce the likelihood of a missed diagnosis

Anahtar Kelimeler

• Hemothorax
• Spinal deformity
• Posterior correction surgery
• Pediatric spine surgery
• Intraoperative imaging

Etik Beyan

After receiving approval from the Gazi University Clinical Research Ethics Committee (Date: October 18, 2021; Decision no: 02), we retrospectively examined the electronic medical records of pediatric patients who underwent posterior correction surgery for spinal deformity at our institution between 2016 and 2021.

Pediatrik Spinal Deformite Nedeniyle Uygulanan Posterior Düzeltme Cerrahisi Sonrası Gözden Kaçan Hemotoraks

Öz

Giriş: Hemotoraks, spinal deformiteler için posterior düzeltme cerrahisi (PCS) sonrası nadir fakat ciddi bir komplikasyondur ve vakaların yaklaşık %0,1'inde görülür. Tanı geciktiğinde veya durum gözden kaçırıldığında, klinik sonuçlar ciddi olabilir. Bu retrospektif derlemede, PCS sonrası hemotoraks gelişen pediatrik hastaları değerlendirerek, perioperatif tanı zorluklarını ve karşılaşılan tedavi deneyimlerini tanımlamayı amaçladık. Yöntemler: 2016-2021 yılları arasında, spinal deformite nedeniyle posterior düzeltme ameliyatı geçiren 135 çocuğun kayıtlarını retrospektif olarak inceledik. Bu hastalardan beşine postoperatif hemotoraks tanısı konuldu ve çalışmaya dahil edildi. Değerlendirilen değişkenler demografik bilgiler, intraoperatif görüntüleme bulguları, hemodinamik bozulmanın başlangıcı ve uygulanan tedavilerden oluşuyordu. Bulgular: Ameliyat sırasındaki ortalama hasta yaşı 12,4 ± 2,9 yıldı. Spinal enstrümantasyonun yerleşimini doğrulamak için rutin olarak ameliyat sırasında posteroanterior göğüs radyografileri çekildi. Bu filmlerin retrospektif incelemesinde dört çocukta net hemotoraks belirtileri, birinde ise şüpheli bulgular görüldü. Olguların hiçbirine hemotoraks için ameliyat sırasında müdahale edilmedi. Daha sonra gelişen hemodinamik instabilite nedeniyle beş hasta da ameliyattan sonra farklı zamanlarda servisten yoğun bakım ünitesine transfer edildi. Üç hastada göğüs tüpü drenajı, birinde torasentez ve bir diğerinde cerrahi dekortikasyon gerekti. Sonuç: Hemotoraksın erken tanısı, postoperatif komplikasyonların önlenmesinde önemli bir rol oynar. Daha yüksek risk altında olduğu düşünülen hastalarda, ameliyat sırasında yatak başı torasik ultrasonografi rutin olarak kullanılmalıdır. Bu seçenek mümkün olmadığında, ekstübasyondan önce ters Trendelenburg pozisyonunda göğüs röntgeni çekilmesi, tanı atlanma olasılığını azaltmaya yardımcı olabilir.

Anahtar Kelimeler

• Hemotoraks
• Spinal deformite
• Posterior düzeltme cerrahisi
• Pediatrik omurga cerrahisi
• İntraoperatif görüntüleme.

Kaynakça

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