Life‐Threatening Posttonsillectomy Hemorrhage

Abstract

In rare cases, the intensity of posttonsillectomy hemorrhage (PTH) may become life-threatening requiring major surgical means and intensive care. This study was conducted to assess the outcome of life-threatening PTH and its clinical features in a larger patient population. Cases occurring during the clinical career of the authors were collected and added by own expert reports to lawsuits and professional boards in cases who had undergone tonsillectomy elsewhere. PTH resulting in hemorrhagic shock requiring resuscitation, ligature of greater arteries in the neck, tracheotomy, packing of the pharynx, embolization, and/or blood transfusions were labeled as life threatening. Seventy-nine patients had experienced life-threatening PTH between 1980 and 2006, comprising 36 children and 39 adults (age not stated for 4 patients). There were 42 female and 34 male patients (gender not stated for 3 patients). Only nine patients experienced primary bleeding, secondary PTH clearly prevailed (n = 70; 89.6%) in this patient population. Single episodes of life-threatening PTH were reported for 11 cases including two patients with and nine without remaining neurological sequelae. Three of the 11 patients were children (age not stated for 2 patients). Repeated episodes of life-threatening PTH occurred in 68 patients (32 children) including eight with remaining sequelae. Life-threatening PTH is an apparently rare, most commonly unpredictable state of emergency requiring a clear management protocol. However, repeated episodes of bleeding classified most clinical courses and should alert the medical staff. Although the bleeding rate after tonsillectomy in children is generally acknowledged to be very low, the rate of life-threatening PTH is apparently higher than in adults. Gender seems not to be a risk factor. Secondary PTH can no longer be assessed to be less dangerous than primary PTH.