Delayed near-fatal hemorrhage after Nuss bar displacement Katherine Barsness a,b , Jennifer Bruny a,b , Joseph S. Janik c, * , David A. Partrick a,b a Department of Pediatric Surgery, The Children’s Hospital, Denver, CO 80218, USA b Department of Surgery, University of Colorado Health Sciences Center, Denver, CO 80218, USA c Arizona Children’s Surgery, Banner Children’s Hospital, Mesa, AZ 85202, USA Abstract A novel case of Nuss bar displacement with near-fatal hemorrhage 3 months after insertion and 3 weeks after unreported bar movement is presented. Salient features of presentation, evaluation, and treatment are described including how to divide the bar from an intrathoracic approach. D 2005 Elsevier Inc. All rights reserved. Displacement of the Nuss bar is one of the most com- monly recorded complications after the Nuss procedure for pectus excavatum [1-3]. Rarely, displacement causes pseu- doaneurysm of the internal mammary artery [2]. The only episodes of hemorrhage associated with the Nuss procedure have occurred with cardiac perforation and injury of an intercostal vessel [1-3]. In this report, we document our experience with an adolescent who had bar displacement and near-fatal hemorrhage from an internal mammary artery. This report has been reviewed and approved by the Colorado Multiple Institutional Review Board (COMIRB no. 02-618). 1. Case report A 13-year-old adolescent boy underwent an uneventful thorascopic-assisted Nuss procedure. Nine weeks later, he felt the bar move and assume a different location. The change in position did not alter his appearance and was only annoying. Three weeks later, he experienced acute onset of right-sided chest pain and shortness of breath. He presented to a community hospital where a chest x-ray revealed an opacification of his right chest and a 458 upward rotation of the bar (Figs. 1 and 2). His hematocrit was 41 mg/dL. He was 0022-3468/$ – see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2005.07.038 T Corresponding author. Arizona Children’s Surgery, Mesa, AZ 85202, USA. Tel.: +1 480 464 9400; fax: +1 480 464 9401. E-mail address: joseph.janik@bannerhealth.com (J.S. Janik). Index words: Nuss bar; Hemorrhage; Pectus excavatum; Artery Fig. 1 Posteroanterior x-ray of the thorax demonstrating opacification of the right hemithorax. Journal of Pediatric Surgery (2005) 40, E5–E6 www.elsevier.com/locate/jpedsurg