PubMed · 11957253
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I M Macharia. 2001. Adenotonsillectomy.. https://doi.org/10.4314/eamj.v78i7.9002
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Foreign body ingestion is an important emergency occurring in childhood. In this article, we report the case of a 5-year-old girl with marble impaction in the nasopharynx, which had not been discovered by routine X-rays of the chest and abdomen at the time of ingestion. The patient presented 4 months after the event with typical symptoms of adenoid hypertrophy and sinusitis, and the diagnosis was established on the basis of a plain film of the nasopharynx. This rare situation is potentially dangerous, since the foreign body may descend and cause sudden airway obstruction. Therefore, in all cases with vanishing foreign bodies in the aerodigestive system, nasopharyngeal impaction and its fatal consequences should be kept in mind and endoscopic examination of the region should be considered.
BACKGROUND: Adenoidectomy, with or without tonsillectomy, remains as one of the most common surgical procedures. This study was undertaken to determine whether or not the criteria for adenoidectomy based on an inpatient basis in our hospital have to be revised and to evaluate the incidence of postoperative bleeding. MATERIAL AND METHODS: The data of 470 patients who underwent adenoidectomy during 1 year were analyzed in a prospective study. Age <1 year; age >16 years; underlying diseases that put the patient at increased pre-or postoperative cardiopulmonary, metabolic or general risk; >20 minutes driving time between hospital and home, lack of compliance; request of the patients/parents were criteria for adenoidectomy to be performed as an inpatient procedure. Due to the rarity of postoperative bleeding the rate of post-adenoidectomy hemorrhage was calculated in a retrospective study on the basis of the data of 8131 patients who had undergone adenoidectomy. RESULTS: A total of 249 patients underwent adenoidectomy on an outpatient basis (53%). Two patients required surgical treatment for postoperative bleeding under general anesthesia (0.43%), one of whom was initially scheduled for outpatient surgery. The parents of 17 children initially scheduled for outpatient surgery refused to take responsibility of postoperative care on the day of surgery. These children were admitted. Inpatient observation was scheduled in most cases because of the distance to the hospital (115 patients) or underlying diseases (7 patients). The rate of post-adenoidectomy hemorrhage in our retrospective study was 0.23%. There was only one adult with repeated bleeding on the day of surgery and 6 days postoperatively. 15 of 19 episodes of bleeding occurred on the day of surgery, the latest episode 6 days postoperatively. There was no case with lethal outcome. No blood transfusions or major surgical procedures at the neck were required to stop the bleeding. CONCLUSIONS: Inpatient observation should be considered in patients with underlying general diseases, postoperative bleeding, poor compliance or request of the patients/parents. Age, general risk of post-adenoidectomy hemorrhage and distance to the hospital are not criteria significant enough to indicate inpatient observation in patients who undergo adenoidectomy.
Cases of the new variant Creutzfeldt-Jakob disease (vCJD) in human beings have to be anticipated in Germany. In subclinical vCJD, the accumulation of prions in lymphoid tissue has been identified prior to their manifestation in cerebral tissue. The remarkable resistance of prions to standard methods of sterilisation questions the safety of reusing metallic surgical instruments. The transmission of vCJD via such reusable surgical instruments in tonsillectomies and adenoidectomies cannot be excluded. In this study, 96 tonsillectomies and adenoidectomies were performed with disposable instruments made of a high performance polymer (Aesculap, Tuttlingen). No increase in the number of intra- or postoperative complications was evident. These disposable instruments may represent an alternative to reusable metallic surgical instruments in potentially infected patients or in patients desiring the use of disposable instruments during their operation for safety reasons.