Lethal post-tonsillectomy hemorrhage.
BACKGROUND
Post-tonsillectomy hemorrhage (PTH) seems to be a rare but unavoidable complication. Due to the frequency of performed tonsillectomies, it can be estimated that a certain amount may result in a lethal outcome. This study was undertaken to evaluate the clinical features of these rare cases.


METHODS
Retrospective case series of five patients with lethal post-tonsillectomy hemorrhage are reported after they had undergone tonsillectomy by four different surgeons. The relevant literature was reviewed.


RESULTS
The youngest patient was 42 months and the oldest almost 13 years old. All patients were male. Three patients had left the hospital against surgeon's recommendation 5 days following tonsillectomy. Preceding episodes of bleeding prior to the lethal bleeding occurred in two patients. Lethal PTH occurred in four patients within 5-9 days, the latest bleeding 39 days after surgery. In the literature, lethal PTH was described for eight patients since 1958. The youngest patient was 4 years, the oldest 18 years old (mean: 8.6 years; median: 6.5 years). In three patients, lethal PTH occurred on the day of surgery and the latest bleeding 54 days after surgery.


CONCLUSIONS
Due to the paucity of reports, little reliable information can be obtained from the literature. It remains unclear, whether or not this reflects the true incidence of this complication. The experience with the five reported cases suggests, that immediate surgical treatment may have avoided lethal outcome in most cases. Therefore, a close postoperative follow-up is advisable to detect any episode of bleeding as soon as possible which should be referred to a specialist. Certainly, the collected data do not suffice to establish general guidelines, indicating that further collection of cases is required to assess characteristics of lethal PTH.
Windfuhr
Jochen P
JP
Department of Otorhinolaryngology, Plastic Head and Neck Surgery, St. Anna Hospital, Albertus Magnus Str. 33, 47259, Duisburg, Germany. jwindfuhr@aol.com
D020212:Carotid Artery Injuries / Q000209:etiology / Q000401:mortality / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D006801:Humans; D008026:Ligation / Q000379:methods; D008297:Male; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D014068:Tonsillectomy / Q000009:adverse effects*; D017211:Treatment Failure