Post - Tonsillectomy Bleeding - Causes and Management
Hemorrhage is a frequent complication of tonsillectomy surgery. The paratonsillar vein running behind the palatine tonsil is a frequent source. The hemorrhage may be divided into: 1. Primary Hemorrhage- It occurs at the time of operation and is usually due to bleeding from the paratonsillar vein in the bed of the tonsil. Management is via simple ligation of the bleeder. 2. Reactionary hemorrhage- This occurs within 24 hours of surgery and may either be due to slipping of the ligature or due to a systemic cause such as high blood pressure. It may also happen if the patient coughs or vomits violently. If excessive, the patient is taken back to the OR and the bleeders are ligated or cauterized under general anesthesia. 3. Secondary Hemorrhage- It may occur upto 2 weeks following surgery but is most frequently encountered on the 5th post- operative day. The aetiology is largely infectious and is often accompanied by fever. The patient is managed with antibiotics and observation. If not responding to medical management, the tonsillar fossa may be packed and the fauces stitched together until the problem settles. Image credits: https://blog.fauquierent.net/2015/03/bleeding-after-tonsillectomy-pictures.html
