A case of subcutaneous scalp hematoma and alopecia following total laparoscopic hysterectomy

Abstract

Introduction: In recent years, total laparoscopic hysterectomy (TLH) has become increasingly popular. Compared to abdominal total hysterectomy (ATH), TLH has been reported to require shorter hospital stays and is associated with reduced blood loss and less postoperative pain. However, TLH carries a higher risk of complications such as ureteral injury and compartment syndrome, especially in obese patients. Here, we report a case of TLH complicated by postoperative subcutaneous scalp hematoma and alopecia.

Case: The patient was a 44-year-old woman with a history of diabetes mellitus and hyperlipidemia, and a BMI of 30, with gravida 3, para 2 obstetric history. She presented with frequent urination as the main complaint. She was referred to our department after being diagnosed with uterine fibroids. Following a course of pseudo-menopausal therapy, TLH was performed. After anesthesia recovery, the patient complained of occipital pain. On postoperative day 1, ultrasonography revealed a subcutaneous fluid collection in the occipital region, diagnosed as a subcutaneous hematoma. The hematoma gradually decreased in size and resolved by postoperative day 24, but alopecia developed in the affected area.

Discussion: Although rare, alopecia has been reported as a postoperative complication. In this case, the development of a subcutaneous scalp hematoma followed by alopecia suggests that pressure-induced circulatory impairment was the likely cause. Risk factors for postoperative alopecia include prolonged surgery, intraoperative hypotension, blood loss, anemia, and hypothermia. Additionally, the effects of the Trendelenburg position, obesity, and even psychiatric conditions have been implicated.

Conclusion: While postoperative alopecia is rare and typically self-limiting, it can occasionally become permanent, emphasizing the need for preventive measures.