Traumatic haemorrhage of the thyroid is an uncommon injury, especially in patients without pre-existing thyroid disease. Goitrous glands have an increased risk of haemorrhage following trauma due to their increased size and vascularity. Traditionally, traumatic thyroid haematomas were indiscriminately managed with neck exploration. Over time, the role of the close observation in the management of these injuries was explored, and it became common for patients with traumatic haematomas in otherwise normal thyroid glands to be managed non-operatively if no signs of ongoing bleeding or airway compromise manifested. However, patients with known goitrous glands continued to undergo neck exploration and resection of the affected gland. Herein we discuss the case of a traumatic thyroid haematoma managed non-operatively in a patient with a goitrous gland and discuss its implications for the management of similar future cases.
A 73-year-old woman presented with fever and right flank pain. The admission was complicated by sepsis, myocardial ischaemia and an upper gastrointestinal bleed. A gastroscopy eventually demonstrated a large antral adenocarcinoma. Further imaging showed no evidence of metastasis, but demonstrated a large segment 3 hepatic abscess. At laparotomy, a hepatogastric fistula (HGF) was noted and a synchronous subtotal gastrectomy and left lateral liver sectionectomy was performed. Final histology showed complete resection of the gastric cancer (T4bN2) and confirmed the presence of the fistula. The patient was discharged 10 days later. She passed away 6 months later with local recurrence, hepatic and pulmonary metastasis. We include a review summarising the other causes of HGF in the literature.
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