Meningitis after adenoidectomy: an anatomic explanation.
Meningitis is a rare complication of adenoidectomy. During a 5-month period, two children at St Christopher's Hospital for Children developed meningitis within days following this surgical procedure. The potential causes of this complication that we investigated include coincidence, systemic hematogenous spread of bacteria to the central nervous system, and direct or indirect contamination of the cerebrospinal fluid by bacteria introduced by retropharyngeal injection of lidocaine hydrochloride and epinephrine. Based on statistical analysis of the available literature and anatomic studies of the pediatric nasopharyngeal region, we conclude that a retrograde flow of bacteria via a newly described anastomotic network of veins was the most likely cause of this sequela.
Isaacson
G
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Department of Pediatric Otolaryngology, St Christopher's Hospital for Children, Philadelphia, Pennsylvania.
Parke
W W
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D000233:Adenoidectomy / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002102:Cadaver; D002675:Child, Preschool; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007267:Injections; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008583:Meningitis, Haemophilus / Q000209:etiology*; D008586:Meningitis, Pneumococcal / Q000209:etiology*; D009305:Nasopharynx / Q000098:blood supply; D013346:Subarachnoid Space / Q000098:blood supply; D014680:Veins / Q000033:anatomy & histology
D000779:Anesthetics, Local; D008012:Lidocaine; D004837:Epinephrine