Delayed Postoperative Hemorrhage After Laparoscopic Adrenalectomy

Naohiro Sata, MD, PhD, Kazuhiro Endo, MD, Yasunaru Sakuma, MD, PhD, Alan Lefor, MD, MPH,
Yoshikazu Yasuda, MD, PhD, Ken Koyama, MD, PhD, Hideki Abe, MD, PhD,
Hideo Nagai, MD, PhD

Department of Surgery, Jichi Medical University, Yakushiji Shimotsuke Tochigi, Japan
(Drs. Sata, Endo, Sakuma, Lefor, Yasuda).
Ibaraki Prefectural Central Hospital, Koibuchi Kasama Ibaraki, Japan (Drs. Koyama, Abe, Nagai)

ABSTRACT

Introduction: The current standard surgical approach for benign adrenal disease is laparoscopic adrenalectomy. Both the transperitoneal and retroperitoneal approaches have been successfully used. We describe the unusual complication of delayed retroperitoneal hemorrhage.

Case Description: The patient is a 62-year-old man who underwent retroperitoneal laparoscopic adrenalectomy. The patient did well initially and was discharged home but presented 11 days postoperatively with abdominal pain and a large hematoma seen on computed tomography scan. An interventional radiology approach with splenic artery coil embolization was successful for management of the hemorrhage.

Discussion: Surgeons must be aware of possible severe delayed complications and the appropriate procedure for the laparoscopic approach, including usage of ultrasonic cutting instruments and delayed postoperative hemorrhage

Key Words: Laparoscopic adrenalectomy, Postoperative hemorrhage, Complication

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