Spontaneous Hemo-Mediastinum Following Laparoscopic Appendectomy: A Case Report

Area of Science:

• Thoracic Surgery
• Interventional Radiology
• Gastrointestinal Surgery

Background:

• Hemo-mediastinum, or intra-thoracic bleeding, is rare, typically linked to trauma, malignancy, or spontaneous events.
• Spontaneous intra-thoracic bleeding post-laparoscopic appendectomy is exceptionally uncommon.
• This case involves a 65-year-old male with comorbidities presenting after an appendectomy.

Purpose of the Study:

• To report a unique case of spontaneous hemo-mediastinum after laparoscopic appendectomy.
• To emphasize the importance of prompt diagnosis and management of this rare complication.

Main Methods:

• A 65-year-old male underwent laparoscopic appendectomy for gangrenous appendicitis.
• Contrast-enhanced CT identified a mediastinal hematoma with active extravasation.
• Interventional radiology procedures included embolization of the bleeding vessel and bronchial artery.
• Surgical intervention involved thoracotomy for hematoma evacuation.

Main Results:

• The patient developed massive mediastinal hematoma and hemodynamic instability post-appendectomy.
• Initial interventional radiology embolization was followed by a second procedure for persistent hemoptysis.
• Surgical evacuation of the hematoma led to stabilization and recovery.
• This is the first reported case of post-appendectomy hemo-mediastinum.

Conclusions:

• Spontaneous hemo-mediastinum is an unusual complication of laparoscopic appendectomy.
• Timely and multidisciplinary intervention, including interventional radiology and surgery, is vital.
• This case underscores the need for vigilance in diagnosing rare post-operative complications.