title: Life-threatening hemorrhage during removal of a Nuss bar associated with sternal erosion.
abstract: We present a case of life-threatening hemorrhage occurring during Nuss bar removal without obvious cardiac or major vascular injury. A 19-year-old woman with marfanoid features had undergone a Nuss procedure 3 years earlier for a pectus index of 7.2. A lateral chest radiograph revealed erosion of the upper bar into the sternum. During surgery, a 3.5-L blood loss occurred after removal of the eroded bar. This case provided many opportunities to improve preparedness for bar removal.
authors.affiliation: Department of Surgery, Phoenix Children's Hospital, Phoenix, Arizona; University of Arizona College of Medicine Phoenix, Phoenix, Arizona; Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona. Electronic address: dnotrica@phoenixchildrens.com.
authors.forename: David M
authors.initials: DM
authors.lastname: Notrica
authors.affiliation: Department of Surgery, Phoenix Children's Hospital, Phoenix, Arizona; University of Arizona College of Medicine Phoenix, Phoenix, Arizona; Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona.
authors.forename: Lisa E
authors.initials: LE
authors.lastname: McMahon
authors.affiliation: Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona.
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Johnson
authors.affiliation: Department of Surgery, Phoenix Children's Hospital, Phoenix, Arizona; University of Arizona College of Medicine Phoenix, Phoenix, Arizona.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Velez
authors.affiliation: Department of Surgery, Phoenix Children's Hospital, Phoenix, Arizona; University of Arizona College of Medicine Phoenix, Phoenix, Arizona; Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona.
authors.forename: Leigh C
authors.initials: LC
authors.lastname: McGill
authors.affiliation: Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona.
authors.forename: Dawn E
authors.initials: DE
authors.lastname: Jaroszewski
mesh_terms: D000293:Adolescent; D001860:Bone Plates / Q000009:adverse effects*; D020878:Device Removal / Q000009:adverse effects*; D004630:Emergencies; D005260:Female; D005660:Funnel Chest / Q000601:surgery; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D013249:Sternum / Q000293:injuries*