The investigation of deaths that are suspected to be related to medical therapy present several challenges for a forensic pathologist. We present a case of an otherwise healthy 58-year-old woman with multiple nasal polyps who underwent nasal polypectomy. The operation was initially considered successful. However, the patient had never recovered from general anesthesia and was declared deceased 24 hours after the surgery.
The autopsy revealed a basilar subarachnoid hemorrhage. The examination of the basilar skull showed a perforation of approximately 15 by 7 mm in the right cribriform plate. Above the bone perforation, there was a disruption of the dura and a 20-mm-long penetrating wound within the right frontal lobe parenchyma of the brain, with associated intraventricular hemorrhage. The subsequent sectioning of the formalin-fixed brain revealed extensive parenchymal destruction. The cause of death was certified as complications of nasal/sinus surgery, with a perforation of the skull base with hemorrhagic tissue destruction, whereas the manner of death was considered accidental.
Common nasal surgical procedures and known complications are discussed.
From the *Department of Forensic Medicine, Clinical Center of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
†Institute of Forensic Medicine “Milovan Milovanovic,” School of Medicine, University of Belgrade, Belgrade, Serbia.
Manuscript received April 15, 2019; accepted June 8, 2019.
The authors report no conflict of interest.
This work was supported by the Ministry of Education and Science of the Republic of Serbia (N° III 41022 and OI 175093).
Reprints: Tijana Durmić, MD, PhD, Institute of Forensic Medicine “Milovan Milovanovic,” School of Medicine, University of Belgrade, Deligradska 31a, Belgrade, Serbia. E-mail: email@example.com.