Post-tonsillectomy pseudoaneurysm: an underestimated entity?
OBJECTIVE
To identify patients undergoing arteriography to verify vascular complications of tonsillectomy, with an emphasis on pseudoaneurysm.


METHODS
We undertook a retrospective analysis of the case records of 8837 patients who had undergone tonsillectomy between 1988 and 2004 at our institution, together with a review of expert reports written for professional boards and civil courts as well as personal experiences or communication. We also conducted a literature review using the PubMed database.


RESULTS
We identified seven cases with vascular abnormalities. In addition, we identified three cases of pseudoaneurysm formation, involving two children and one adult patient, with bleeding 21, 36 and 58 days after tonsillectomy. Successful management included embolisation (two patients) and revision surgery (one patient).


CONCLUSIONS
Post-tonsillectomy pseudoaneurysm formation is extremely rare and unrestricted by age. Correct diagnosis depends largely on a high index of clinical suspicion. Delayed and repeated episodes of gushing haemorrhage with spontaneous cessation appear to be a significant clinical marker. Immediate arteriography, with simultaneous embolisation, is highly recommended. The lingual artery is the most commonly involved vessel.
Windfuhr
J P
JP
Department of ORL Malteser Krankenhaus St. Anna Duisburg, Germany. jochen.windfuhr@malteser.de
Sesterhenn
A M
AM
Schloendorff
G
G
Kremer
B
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D017541:Aneurysm, False / Q000209:etiology* / Q000628:therapy; D000792:Angiography; D001158:Arteries; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D014059:Tongue / Q000098:blood supply; D014068:Tonsillectomy / Q000009:adverse effects*; D055815:Young Adult