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Volume 4, Issue 3 (2023)
J Clinic Care Skill 2023, 4(3): 143-148 |
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Received: 2023/05/24 | Accepted: 2023/09/5 | Published: 2023/09/17
Received: 2023/05/24 | Accepted: 2023/09/5 | Published: 2023/09/17
How to cite this article
Ganjali H, Hedjazi A, Attaran H. Medicolegal Aspects of Life-Threatening Late Hemorrhage after Tonsillectomy; a Report of Three Cases. J Clinic Care Skill 2023; 4 (3) :143-148
URL: http://jccs.yums.ac.ir/article-1-193-en.html
URL: http://jccs.yums.ac.ir/article-1-193-en.html
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Medicolegal Aspects of Life-Threatening Late Hemorrhage after Tonsillectomy; a Report of Three Cases
1- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
2- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran ,hmdattaran@yahoo.com
2- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran ,
Abstract (1646 Views)
Aims: Secondary bleeding after tonsillectomy is unavoidable. If it leads to a life-threatening event, it will likely be associated with a malpractice claim against the surgeon. Very few reports have addressed this event from a medicolegal point of view. Therefore, the present report aimed to investigate litigations following secondary post-tonsillectomy hemorrhage leading to death or life-threatening events in three patients.
Patients & Methods: Here, we report three cases of life-threatening secondary post-tonsillectomy hemorrhage referred to the Legal Medicine Organization by the prosecuting attorney to give an expert opinion about any medical negligence.
Findings: Two cases resulted in death and underwent medicolegal autopsy. The third one caused a cardiopulmonary arrest followed by neurological deficits after successful resuscitation. All three were children between 8 and 9 years old, and the time from surgery to post-tonsillectomy hemorrhage was between 30 hours to 13 days. No vascular anomaly or iatrogenic vascular injuries were found at autopsy. A review of the literature revealed that post-tonsillectomy hemorrhage is common and unpreventable
Conclusion: In none of the cases medical malpractice was found as a contributing factor, and the complication was regarded as unpreventable.
Patients & Methods: Here, we report three cases of life-threatening secondary post-tonsillectomy hemorrhage referred to the Legal Medicine Organization by the prosecuting attorney to give an expert opinion about any medical negligence.
Findings: Two cases resulted in death and underwent medicolegal autopsy. The third one caused a cardiopulmonary arrest followed by neurological deficits after successful resuscitation. All three were children between 8 and 9 years old, and the time from surgery to post-tonsillectomy hemorrhage was between 30 hours to 13 days. No vascular anomaly or iatrogenic vascular injuries were found at autopsy. A review of the literature revealed that post-tonsillectomy hemorrhage is common and unpreventable
Conclusion: In none of the cases medical malpractice was found as a contributing factor, and the complication was regarded as unpreventable.
Keywords:
References
1. Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA, et al. Clinical practice guideline: Tonsillectomy in children (Update). Otolaryngol Head Neck Surg. 2019;160(2):187-205. [Link] [DOI:10.1177/0194599818807917]
2. Liu Y, Yan Z, Guo H, Xu Q, Li Z, Lin J. Rare and fatal complications of tonsillectomy: Sudden pneumothorax and extensive subcutaneous emphysema. J Int Med Res. 2022;50(7):3000605221112369. [Link] [DOI:10.1177/03000605221112369]
3. Collison PJ, Mettler B. Factors associated with posttonsillectomy hemorrhage. Ear Nose Throat J. 2000;79(8):640-2. [Link] [DOI:10.1177/014556130007900820]
4. Windfuhr JP, Chen YS, Remmert S. Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients. Otolaryngol Head Neck Surg. 2005;132(2):281-6. [Link] [DOI:10.1016/j.otohns.2004.09.007]
5. Francis DO, Fonnesbeck C, Sathe N, McPheeters M, Krishnaswami S. Postoperative bleeding and associated utilization following tonsillectomy in children. Otolaryngol Head Neck Surg. 2017;156(3):442-55. [Link] [DOI:10.1177/0194599816683915]
6. Lee WC, Sharp JF. Complications of paediatric tonsillectomy post-discharge. J Laryngol Otol. 1996;110(2):136-40. [Link] [DOI:10.1017/S0022215100132979]
7. Kim DW, Koo JW, Ahn SH, Lee CH, Kim JW. Difference of delayed post-tonsillectomy bleeding between children and adults. Auris Nasus Larynx. 2010;37(4):456-60. [Link] [DOI:10.1016/j.anl.2009.11.011]
8. Windfuhr JP, Schloendorff G, Baburi D, Kremer B. Lethal outcome of post-tonsillectomy hemorrhage. Eur Arch Otorhinolaryngol. 2008;265(12):1527-34. [Link] [DOI:10.1007/s00405-008-0699-4]
9. Ragab A, Amin S, Abdel Fatah A, Rahman T, Abdelhakim M. Analysis of tonsillectomy malpractice claims in Egypt: 2010-2015. Menoufia Med J. 2018;31(4):1277-81. [Link]
10. Stevenson AN, Myer CM, Shuler MD, Singer PS. Complications and legal outcomes of tonsillectomy malpractice claims. Laryngoscope. 2012;122(1):71-4. [Link] [DOI:10.1002/lary.22438]
11. Windfuhr JP, Schloendorff G, Baburi D, Kremer B. Serious post-tonsillectomy hemorrhage with and without lethal outcome in children and adolescents. Int J Pediatr Otorhinolaryngol. 2008;72(7):1029-40. [Link] [DOI:10.1016/j.ijporl.2008.03.009]
12. Blakley BW. Post-tonsillectomy bleeding: how much is too much?. Otolaryngol Head Neck Surg. 2009;140(3):288- 90. [Link] [DOI:10.1016/j.otohns.2008.12.005]
13. Liu JH, Anderson KE, Willging JP, Myer CM, Shott SR, Bratcher GO, et al. Posttonsillectomy hemorrhage: What is it and what should be recorded?. Arch Otolaryngol Head Neck Surg. 2001;127(10):1271-5. [Link] [DOI:10.1001/archotol.127.10.1271]
14. Morris LG, Lieberman SM, Reitzen SD, Edelstein DR, Ziff DJ, Katz A, et al. Characteristics and outcomes of malpractice claims after tonsillectomy. Otolaryngol Head Neck Surg. 2008;138(3):315-20. [Link] [DOI:10.1016/j.otohns.2007.11.024]
15. Bhattacharyya N. Evaluation of post-tonsillectomy bleeding in the adult population. Ear Nose Throat J. 2001;80(8):544-9. [Link] [DOI:10.1177/014556130108000817]
16. Castellano P, López-Escámez JA. American society of anesthesiology classification may predict severe posttonsillectomy haemorrhage in children. J Otolaryngol. 2003;32(5):302-7. [Link] [DOI:10.2310/7070.2003.11420]
17. Windfuhr JP. Lethal post-tonsillectomy hemorrhage. Auris Nasus Larynx. 2003;30(4):391-6. [Link] [DOI:10.1016/j.anl.2003.07.004]
18. Jena AB, Seabury S, Lakdawalla D, Chandra A. Malpractice risk according to physician specialty. N Engl J Med. 2011;365(7):629-36. [Link] [DOI:10.1056/NEJMsa1012370]
19. Shin JI. Dexamethasone and postoperative bleeding after tonsillectomy in children. JAMA. 2009;301(17):1764;5-6. [Link] [DOI:10.1001/jama.2009.574]
20. Scheckenbach K, Bier H, Hoffmann TK, Windfuhr JP, Bas M, Laws HJ, et al. Risk of hemorrhage after adenoidectomy and tonsillectomy. Value of the preoperative determination of partial thromboplastin time, prothrombin time and platelet count. HNO. 2008;56(3):312-20 [Link] [DOI:10.1007/s00106-007-1585-x]
21. Eistert B, Kirchmaier C, Risse M, Glanz H. Disorders of thrombocyte function as a cause of postoperative hemorrhage after tonsillectomy. HNO. 1995;43(3):177-81. [Link]
22. Rohrer MJ, Michelotti MC, Nahrwold DL. A prospective evaluation of the efficacy of preoperative coagulation testing. Ann Surg. 1988;208(5):554-7. [Link] [DOI:10.1097/00000658-198811000-00002]
23. Krishna P, Lee D. Post-tonsillectomy bleeding: a metaanalysis. Laryngoscope. 2001;111(8):1358-61. [Link] [DOI:10.1097/00005537-200108000-00008]
24. Oghan F, Turan N, Ertan A. Malpractice lawsuits in otorhinolaryngology. Salud(i)Ciencia. 2013;19(8):703-7. [Link]
25. Cushing M. Legal lessons on patient teaching. Am J Nurs. 1984;84(6):721-2. [Link] [DOI:10.1097/00000446-198406000-00014]