Intraoperative ear bleeding with bilateral otorrhagia during laparoscopic sacrocolpopexy

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.

CASE: 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.