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[A severe late tonsillar hemorrhage 2 months postoperatively].

H Swoboda¹, B Welleschik

¹I. HNO-Klinik der Universität Wien.

Laryngologie, Rhinologie, Otologie

|August 1, 1988

Summary

A rare case of severe, delayed post-tonsillectomy hemorrhage in a child was successfully treated. The study highlights the risk of external carotid artery injury during tonsillectomy, even after initial hemostasis.

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Area of Science:

Otolaryngology
Pediatric Surgery
Vascular Surgery

Background:

Tonsilloadenoidectomy is a common pediatric surgical procedure.
Postoperative hemorrhage is a known complication, typically occurring within the first 24 hours.
Delayed severe hemorrhage is uncommon but can be life-threatening.

Observation:

An 8-year-old girl experienced severe, recurrent hemorrhages 5-25 days post-tonsilloadenoidectomy, causing hypovolemia.
Hemorrhages originated from the left tonsillar niche and primarily occurred in the early morning, ceasing spontaneously.
Two months postoperatively, revision revealed a hemosiderin-stained canal leading to massive hemorrhage upon mucosal removal.

Findings:

Massive hemorrhage was controlled by external carotid artery ligation and tonsillar bed suturing.
The arterial lesion is hypothesized to result from tonsil enucleation or initial suture ligation.
Branches of the external carotid artery may be anatomically positioned close to the inferior tonsil.

Implications:

This case underscores the potential for delayed, severe bleeding after tonsillectomy due to arterial injury.
It emphasizes the importance of considering vascular anomalies and precise surgical technique in tonsillectomy.
Awareness of close proximity of external carotid artery branches is crucial for preventing such complications.

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