We have located links that may give you full text access.
Case Reports
English Abstract
Journal Article
[Life threatening and fatal complications of radical neck dissection].
BACKGROUND: Between 1990 and 1999, 395 neck dissections were performed in 357 patients: 195 left-sided (105 of these radical) and 200 right-sided (107 of these radical). Life-threatening complications occurred in four cases and two patients died.
CASE REPORTS: After left-sided radical neck dissection with chylous fistula, a chylothorax resulted, which could not be controlled in spite of chest tube drainage and thoracotomy so that the 75-year-old female patient died 30 days postoperatively. A 66-year-old man died 35 days after a functional neck dissection of the left side because of extreme chylous flow of up to 7 l/day in spite of parenteral nutrition, local surgical revision, and intrathoracic ligation of the thoracic duct. Undetected cirrhosis of the liver was regarded to be the reason for this extremely increased lymph flow. In a 63-year-old man, a jugular foramen hemorrhage during radical neck dissection could only be managed after 3 h and approximately 6 l of blood loss. In a 66-year-old man, a discrete injury of the pleura led to cardiovascular failure due to a tension pneumothorax with mediastinal shift about 45 min later, which required immediate chest tube placement.
DISCUSSION: In none of these unusual cases, which accounted for 1% of all evaluated interventions, had the patients been informed about the observed complication. However, no legal consequences resulted. Nevertheless, dramatic courses of chylous fistulas and rare complications should be considered both forensically when seeking informed consent and clinically.
CASE REPORTS: After left-sided radical neck dissection with chylous fistula, a chylothorax resulted, which could not be controlled in spite of chest tube drainage and thoracotomy so that the 75-year-old female patient died 30 days postoperatively. A 66-year-old man died 35 days after a functional neck dissection of the left side because of extreme chylous flow of up to 7 l/day in spite of parenteral nutrition, local surgical revision, and intrathoracic ligation of the thoracic duct. Undetected cirrhosis of the liver was regarded to be the reason for this extremely increased lymph flow. In a 63-year-old man, a jugular foramen hemorrhage during radical neck dissection could only be managed after 3 h and approximately 6 l of blood loss. In a 66-year-old man, a discrete injury of the pleura led to cardiovascular failure due to a tension pneumothorax with mediastinal shift about 45 min later, which required immediate chest tube placement.
DISCUSSION: In none of these unusual cases, which accounted for 1% of all evaluated interventions, had the patients been informed about the observed complication. However, no legal consequences resulted. Nevertheless, dramatic courses of chylous fistulas and rare complications should be considered both forensically when seeking informed consent and clinically.
Full text links
Related Resources
Trending Papers
The 'Ten Commandments' for the 2023 European Society of Cardiology guidelines for the management of endocarditis.European Heart Journal 2024 April 18
Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies.Journal of Personalized Medicine 2024 Februrary 4
A Guide to the Use of Vasopressors and Inotropes for Patients in Shock.Journal of Intensive Care Medicine 2024 April 14
Prevention and treatment of ischaemic and haemorrhagic stroke in people with diabetes mellitus: a focus on glucose control and comorbidities.Diabetologia 2024 April 17
Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association.Circulation 2024 April 19
Eosinophilic Esophagitis: Clinical Pearls for Primary Care Providers and Gastroenterologists.Mayo Clinic Proceedings 2024 April
Essential thrombocythaemia: A contemporary approach with new drugs on the horizon.British Journal of Haematology 2024 April 9
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app