From the Milwaukee County Medical Examiner's Office.
Department of Pathology, Medical College of Wisconsin, Milwaukee, WI.
Am J Forensic Med Pathol. 2021 Jun 1;42(2):182-185. doi: 10.1097/PAF.0000000000000630.
Resorbable topical hemostatic agents are widely used in surgical procedures to control intraoperative bleeding. There have been multiple reports of complications from use of these agents, including pulmonary vasculature thromboembolism, cerebral venous sinus occlusion, and postoperative inflammatory mass lesions each containing the hemostatic agent. We report 2 cases of inadvertent intra-arterial embolization of hemostatic agent. Both cases followed elective surgical cervical spinal procedures, during which gelatin-based local hemostatic agents were used to control unanticipated bleeding. Postoperatively, both patients exhibited neurologic defects and were found to have infarcts of the brain. At autopsy, vertebrobasilar thromboemboli containing foreign material grossly and microscopically consistent with hemostatic matrix material were found in both cases. These are the first reports of hemostatic agent embolization resulting in cerebral infarcts and leading to death.
可吸收局部止血剂在外科手术中被广泛用于控制术中出血。已有多份关于使用这些制剂引起并发症的报告，包括肺血管血栓栓塞、脑静脉窦阻塞以及术后包含止血剂的炎症性肿块病变。我们报告了 2 例意外动脉内栓塞止血剂的病例。这两例均在择期进行的颈椎手术过程中发生，在此期间使用了基于明胶的局部止血剂来控制意外出血。术后，两名患者均出现神经功能缺损，并发现脑梗死。尸检时，在这两例患者中均发现了含有与止血基质材料大体上和显微镜下一致的异物的椎基底动脉血栓栓塞。这是首例因止血剂栓塞导致脑梗死并导致死亡的报告。
