title: Pitfalls of operative management of secondary post-tonsillectomy haemorrhage--a case report.
abstract: BACKGROUND
  The authors present a potential complication associated with the surgical management of post-tonsillectomy haemorrhage using absorbable cellulose haemostatic dressings. The article discusses the deficiencies of our current understanding of how best to manage this common and potentially life-threatening ENT emergency.
  
  
  METHODS
  A 40-year-old man presented to Accident-and-Emergency with a post-tonsillectomy haemorrhage on the 7th postoperative day. The bleeding was managed surgically, with suturing of the faucial pillars incorporating a piece of Surgicel into the closure. Two days later the patient experienced an episode of partial airway obstruction, due to a piece of dislodged haemostatic material, owing to failure of the closure. The techniques used in the operative management of post-tonsillectomy bleeding are not formally evaluated or discussed in the current literature, and in some cases are unreliable or even potentially hazardous. Further discussion, research, and formulation of a more stepwise approach would be of considerable benefit.
authors.affiliation: Lister Hospital, Stevenage. tjacques@doctors.org.uk
authors.forename: T
authors.initials: T
authors.lastname: Jacques
authors.affiliation: Lister Hospital, Stevenage.
authors.forename: R
authors.initials: R
authors.lastname: Nash
authors.affiliation: Lister Hospital, Stevenage.
authors.forename: B
authors.initials: B
authors.lastname: Kenway
authors.affiliation: Lister Hospital, Stevenage.
authors.forename: P
authors.initials: P
authors.lastname: Vlastarakos
mesh_terms: D000328:Adult; D002483:Cellulose, Oxidized / Q000008:administration & dosage; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D008297:Male; D011098:Polyglactin 910 / Q000008:administration & dosage; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000601:surgery*; D014068:Tonsillectomy / Q000009:adverse effects*
chemical_list: D002483:Cellulose, Oxidized; D011098:Polyglactin 910; C013695:Surgicel