title: Intraoperative ear bleeding with bilateral otorrhagia during laparoscopic sacrocolpopexy.
abstract: BACKGROUND
  Spontaneous perioperative otorrhagia is an extremely rare entity with only 4 cases reported in the literature to date, all of which were recognized after the termination of the procedure.
  
  
  METHODS
  We describe the first reported case of otorrhagia recognized intraoperatively causing abortion of the procedure in a 60-year-old woman undergoing laparoscopic sacrocolpopexy. Otoscopy by the otolaryngology service revealed multiple intracutaneous hematomas and bleeding in bilateral external auditory canals. Computed tomography scan of the head revealed no intracranial hemorrhage. She underwent postoperative drainage by the otolaryngology service with no permanent ear-related sequelae.
  
  
  CONCLUSIONS
  We present the fifth reported case of spontaneous perioperative otorrhagia, the first of which to be noticed intraoperatively and cause premature termination of the procedure. The etiology is postulated to be increased arterial and venous pressures causing rupture of subcutaneous capillaries. In our case, several factors may have contributed to this event, including steep Trendelenburg patient positioning, intraperitoneal carbon dioxide insufflation from laparoscopy, and an intraoperative hypertensive episode.
authors.affiliation: From the *Department of Urology, Houston Methodist Hospital; †Department of Otolaryngology, Baylor College of Medicine, ‡Baylor College of Medicine, §Department of Obstetrics and Gynecology, Baylor College of Medicine; and ∥Division of Urogynecology, Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX.
authors.forename: Robert
authors.initials: R
authors.lastname: Chan
authors.forename: David
authors.initials: D
authors.lastname: Cuthbertson
authors.forename: Zachary
authors.initials: Z
authors.lastname: Jeng
authors.forename: Gillian
authors.initials: G
authors.lastname: Hsieh
authors.forename: Danielle
authors.initials: D
authors.lastname: Antosh
mesh_terms: D004427:Ear Diseases / Q000209:etiology*; D004431:Ear, External; D005260:Female; D018475:Head-Down Tilt / Q000009:adverse effects / Q000502:physiology; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007431:Intraoperative Complications / Q000209:etiology; D010535:Laparoscopy; D008875:Middle Aged; D056888:Patient Positioning / Q000009:adverse effects; D012447:Sacrum / Q000601:surgery; D014621:Vagina / Q000601:surgery