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Isolated bilateral Tapia's syndrome after liver transplantation: A case report and review of the literature.
World J Hepatol. 2016 Dec 28; 8(36):1637-1644.WJ

Abstract

AIM

To describe one case of bilateral Tapia's syndrome in a liver transplanted patient and to review the literature.

METHODS

We report a case of bilateral Tapia's syndrome in a 50-year-old man with a history of human immunodeficiency virus and hepatitis C virus child. A liver cirrhosis and a bi-nodular hepatocellular carcinoma, who underwent liver transplantation after general anesthesia under orotracheal intubation. Uneventful extubation was performed in the intensive care unit during the following hours. On postoperative day (POD) 3, he required urgent re-laparotomy due to perihepatic hematoma complicated with respiratory gram negative bacilli infection. On POD 13, patient was extubated, but required immediate re-intubation due to severe respiratory failure. At the following day a third weaning failure occurred, requiring the performance of a percutaneous tracheostomy. Five days later, the patient was taken off mechanical ventilation and severe dysphagia, sialorrea and aphonia revealed. A computerized tomography and a magnetic resonance imaging of the head and neck excluded central nervous injury. A stroboscopy showed bilateral paralysis of vocal cords and tongue and a diagnosis of bilateral Tapia's syndrome was performed. With conservative management, including a prompt establishment of a speech and swallowing rehabilitation program, the patient achieved full recovery within four months after liver transplantation. We carried out MEDLINE search for the term Tapia's syndrome. The inclusion criteria had no restriction by language or year but must provide sufficient available data to exclude duplicity. We described the clinical evolution of the patients, focusing on author, year of publication, age, sex, preceding problem, history of endotracheal intubation, unilateral or bilateral presentation, diagnostic procedures, type of treatment, follow-up, and outcome.

RESULTS

Several authors mentioned the existence of around 70 cases, however only 54 fulfilled our inclusion criteria. We found only five published studies of bilateral Tapia's syndrome. However this is the first case reported in the literature in a liver transplanted patient. Most patients were male and young and the majority of cases appeared as a complication of airway manipulation after any type of surgery, closely related to the positioning of the head during the procedure. The diagnosis was founded on a rapid suspicion, a complete head and neck neurological examination and a computed tomography and or a magnetic resonance imaging of the brain and neck to establish the origin of central or peripheral type of Tapia's syndrome and also the nature of the lesion, ischemia, abscess formation, tumor or hemorrhage. Apart from corticosteroids and anti- inflammatory therapy, the key of the treatment was an intensive and multidisciplinary speech and swallowing rehabilitation. Most studies have emphasized that the recovery is usually completed within four to six months.

CONCLUSION

Tapia's syndrome is almost always a transient complication after airway manipulation. Although bilateral Tapia's syndrome after general anesthesia is exceptionally rare, this complication should be recognized in patients reporting respiratory obstruction with complete dysphagia and dysarthria after prolonged intubation. Both anesthesiologists and surgeons should be aware of the importance of its preventing measurements, prompt diagnosis and intensive speech and swallowing rehabilitation program.

Authors+Show Affiliations

Itxarone Bilbao, Cristina Dopazo, Mireia Caralt, Lluis Castells, Elisabeth Pando, Amaia Gantxegi, Ramón Charco, Department of Digestive Surgery, Hepatobiliopancreatic Surgery and Liver Transplant Unit, Hospital Universitario Vall d'Hebrón, CIBERehd, Universidad Autónoma de Barcelona, 08035 Barcelona, Spain.Itxarone Bilbao, Cristina Dopazo, Mireia Caralt, Lluis Castells, Elisabeth Pando, Amaia Gantxegi, Ramón Charco, Department of Digestive Surgery, Hepatobiliopancreatic Surgery and Liver Transplant Unit, Hospital Universitario Vall d'Hebrón, CIBERehd, Universidad Autónoma de Barcelona, 08035 Barcelona, Spain.Itxarone Bilbao, Cristina Dopazo, Mireia Caralt, Lluis Castells, Elisabeth Pando, Amaia Gantxegi, Ramón Charco, Department of Digestive Surgery, Hepatobiliopancreatic Surgery and Liver Transplant Unit, Hospital Universitario Vall d'Hebrón, CIBERehd, Universidad Autónoma de Barcelona, 08035 Barcelona, Spain.Itxarone Bilbao, Cristina Dopazo, Mireia Caralt, Lluis Castells, Elisabeth Pando, Amaia Gantxegi, Ramón Charco, Department of Digestive Surgery, Hepatobiliopancreatic Surgery and Liver Transplant Unit, Hospital Universitario Vall d'Hebrón, CIBERehd, Universidad Autónoma de Barcelona, 08035 Barcelona, Spain.Itxarone Bilbao, Cristina Dopazo, Mireia Caralt, Lluis Castells, Elisabeth Pando, Amaia Gantxegi, Ramón Charco, Department of Digestive Surgery, Hepatobiliopancreatic Surgery and Liver Transplant Unit, Hospital Universitario Vall d'Hebrón, CIBERehd, Universidad Autónoma de Barcelona, 08035 Barcelona, Spain.Itxarone Bilbao, Cristina Dopazo, Mireia Caralt, Lluis Castells, Elisabeth Pando, Amaia Gantxegi, Ramón Charco, Department of Digestive Surgery, Hepatobiliopancreatic Surgery and Liver Transplant Unit, Hospital Universitario Vall d'Hebrón, CIBERehd, Universidad Autónoma de Barcelona, 08035 Barcelona, Spain.Itxarone Bilbao, Cristina Dopazo, Mireia Caralt, Lluis Castells, Elisabeth Pando, Amaia Gantxegi, Ramón Charco, Department of Digestive Surgery, Hepatobiliopancreatic Surgery and Liver Transplant Unit, Hospital Universitario Vall d'Hebrón, CIBERehd, Universidad Autónoma de Barcelona, 08035 Barcelona, Spain.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28083087

Citation

Bilbao, Itxarone, et al. "Isolated Bilateral Tapia's Syndrome After Liver Transplantation: a Case Report and Review of the Literature." World Journal of Hepatology, vol. 8, no. 36, 2016, pp. 1637-1644.
Bilbao I, Dopazo C, Caralt M, et al. Isolated bilateral Tapia's syndrome after liver transplantation: A case report and review of the literature. World J Hepatol. 2016;8(36):1637-1644.
Bilbao, I., Dopazo, C., Caralt, M., Castells, L., Pando, E., Gantxegi, A., & Charco, R. (2016). Isolated bilateral Tapia's syndrome after liver transplantation: A case report and review of the literature. World Journal of Hepatology, 8(36), 1637-1644. https://doi.org/10.4254/wjh.v8.i36.1637
Bilbao I, et al. Isolated Bilateral Tapia's Syndrome After Liver Transplantation: a Case Report and Review of the Literature. World J Hepatol. 2016 Dec 28;8(36):1637-1644. PubMed PMID: 28083087.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Isolated bilateral Tapia's syndrome after liver transplantation: A case report and review of the literature. AU - Bilbao,Itxarone, AU - Dopazo,Cristina, AU - Caralt,Mireia, AU - Castells,Lluis, AU - Pando,Elisabeth, AU - Gantxegi,Amaia, AU - Charco,Ramón, PY - 2016/08/19/received PY - 2016/10/14/revised PY - 2016/11/01/accepted PY - 2017/1/14/entrez PY - 2017/1/14/pubmed PY - 2017/1/14/medline KW - Bilateral Tapia’s syndrome KW - Follow-up KW - Liver transplantation KW - Outcome KW - Postoperative complications SP - 1637 EP - 1644 JF - World journal of hepatology JO - World J Hepatol VL - 8 IS - 36 N2 - AIM: To describe one case of bilateral Tapia's syndrome in a liver transplanted patient and to review the literature. METHODS: We report a case of bilateral Tapia's syndrome in a 50-year-old man with a history of human immunodeficiency virus and hepatitis C virus child. A liver cirrhosis and a bi-nodular hepatocellular carcinoma, who underwent liver transplantation after general anesthesia under orotracheal intubation. Uneventful extubation was performed in the intensive care unit during the following hours. On postoperative day (POD) 3, he required urgent re-laparotomy due to perihepatic hematoma complicated with respiratory gram negative bacilli infection. On POD 13, patient was extubated, but required immediate re-intubation due to severe respiratory failure. At the following day a third weaning failure occurred, requiring the performance of a percutaneous tracheostomy. Five days later, the patient was taken off mechanical ventilation and severe dysphagia, sialorrea and aphonia revealed. A computerized tomography and a magnetic resonance imaging of the head and neck excluded central nervous injury. A stroboscopy showed bilateral paralysis of vocal cords and tongue and a diagnosis of bilateral Tapia's syndrome was performed. With conservative management, including a prompt establishment of a speech and swallowing rehabilitation program, the patient achieved full recovery within four months after liver transplantation. We carried out MEDLINE search for the term Tapia's syndrome. The inclusion criteria had no restriction by language or year but must provide sufficient available data to exclude duplicity. We described the clinical evolution of the patients, focusing on author, year of publication, age, sex, preceding problem, history of endotracheal intubation, unilateral or bilateral presentation, diagnostic procedures, type of treatment, follow-up, and outcome. RESULTS: Several authors mentioned the existence of around 70 cases, however only 54 fulfilled our inclusion criteria. We found only five published studies of bilateral Tapia's syndrome. However this is the first case reported in the literature in a liver transplanted patient. Most patients were male and young and the majority of cases appeared as a complication of airway manipulation after any type of surgery, closely related to the positioning of the head during the procedure. The diagnosis was founded on a rapid suspicion, a complete head and neck neurological examination and a computed tomography and or a magnetic resonance imaging of the brain and neck to establish the origin of central or peripheral type of Tapia's syndrome and also the nature of the lesion, ischemia, abscess formation, tumor or hemorrhage. Apart from corticosteroids and anti- inflammatory therapy, the key of the treatment was an intensive and multidisciplinary speech and swallowing rehabilitation. Most studies have emphasized that the recovery is usually completed within four to six months. CONCLUSION: Tapia's syndrome is almost always a transient complication after airway manipulation. Although bilateral Tapia's syndrome after general anesthesia is exceptionally rare, this complication should be recognized in patients reporting respiratory obstruction with complete dysphagia and dysarthria after prolonged intubation. Both anesthesiologists and surgeons should be aware of the importance of its preventing measurements, prompt diagnosis and intensive speech and swallowing rehabilitation program. SN - 1948-5182 UR - https://www.unboundmedicine.com/medline/citation/28083087/Isolated_bilateral_Tapia's_syndrome_after_liver_transplantation:_A_case_report_and_review_of_the_literature_ DB - PRIME DP - Unbound Medicine ER -
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