title: Bilateral otorrhagia: a rare complication of laparoscopic abdominopelvic surgery.
abstract: An 80-year-old woman without any previous otological symptoms underwent laparoscopic abdominoperineal resection for T3N0M0 low rectal carcinoma 4-5 cm from the anal verge. The total operative time was 6 h, of which she spent long hours in the Trendelenburg (35°) position due to difficult pelvic dissection. Midway through the procedure, she developed spontaneous non-traumatic bilateral otorrhagia. This case highlights the potential risk of increased intracranial pressure during prolonged periods of being in a steep Trendelenburg position caused either by the position itself or in combination with carbon dioxide pneumoperitoneum. We also consider the effect of a sudden change from this position to supine as a potential risk.
authors.affiliation: Department of Otolaryngology, Brighton and Sussex University Hospital, Brighton, UK.
authors.forename: Alfred Bentsi
authors.initials: AB
authors.lastname: Addison
authors.affiliation: Department of ENT, Brighton and Sussex University Hospital, Brighton, UK.
authors.forename: Esther
authors.initials: E
authors.lastname: Inarra
authors.affiliation: Brighton and Sussex University Hospital, Brighton, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Watts
mesh_terms: D000005:Abdomen / Q000601:surgery; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D018475:Head-Down Tilt / Q000009:adverse effects*; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D061646:Operative Time; D010388:Pelvis / Q000601:surgery; D010502:Perineum / Q000601:surgery; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D011312:Pressure; D012004:Rectal Neoplasms / Q000601:surgery; D012007:Rectum / Q000473:pathology / Q000601:surgery; D014432:Tympanic Membrane / Q000473:pathology*