Post-tonsillectomy Bleed

Author: Fiqry Fadhlillah / Editor: Frances Balmer / Codes: Published: 02/06/2022

Tonsillectomy is a common procedure performed by ENT surgeons for recurrent infections or obstructive sleep apnoea.

In the UK, post-tonsillectomy haemorrhage occurs in around 5% of patients and is the most common serious complication. The majority of post-tonsillectomy bleeds are self-limiting. However, bleeding can be occult and early identification is important to prevent further complications. Whilst extremely rare, sudden severe haemorrhage is known to occur and can result in death from airway obstruction or hypovolaemic shock.

Learning objectives:

  • Understand the pathophysiology underlying post-tonsillectomy haemorrhage
  • Be able to recognise and clinically assess the patient with a post-tonsillectomy bleed
  • Resuscitate and control bleeding while awaiting ENT intervention in a severe post-tonsillectomy haemorrhage
  • Manage smaller post-tonsillectomy bleeds in the emergency department

References

  1. Ghufoor K, Frosh A, Sandhu G, Hanif J. Post-tonsillectomy patient care in the community. Int J Clin Pract. 2000 Sep;54(7):420-3.
  2. Curtis JL, Harvey DB, Willie S, et al. Causes and costs for ED visits after pediatric adenotonsillectomy. Otolaryngol Head Neck Surg. 2015 Apr;152(4):691-6
  3. Isaacson G. Tonsillectomy care for the pediatrician. Pediatrics. 2012 Aug;130(2):324-34.
  4. Windfuhr JP, Schloendorff G, Baburi D, Kremer B. Serious post-tonsillectomy hemorrhage with and without lethal outcome in children and adolescents. Int J Pediatr Otorhinolaryngol. 2008 Jul;72(7):1029-40.
  5. Peterson J, Losek JD. Post-tonsillectomy hemorrhage and pediatric emergency care. Clin Pediatr (Phila). 2004 Jun;43(5):445-8.
  6. Steketee KG, Reisdorff EJ. Emergency care for posttonsillectomy and postadenoidectomy hemorrhage. Am J Emerg Med. 1995 Sep;13(5):518-23.
  7. Liu JH, Anderson KE, Willging JP, et al. Posttonsillectomy hemorrhage: what is it and what should be recorded? Arch Otolaryngol Head Neck Surg. 2001 Oct;127(10):1271-5.
  8. National Institute for Health and Care Excellence. Electrosurgery (diathermy and coblation) for tonsillectomy. NICE. 2005 Dec 14.

Leave a Reply