Blood, sweat and tears: androgenic-anabolic steroid misuse and recurrent primary post-tonsillectomy haemorrhage.
A 30-year-old male body builder and androgenic-anabolic steroid and insulin abuser was admitted for day case elective tonsillectomy (bipolar). He returned with primary post-tonsillectomy haemorrhage 18 h after the operation and required bipolar cautery to the multiple small bleeding points in the right and left tonsillar fossa. Thorough coagulation screen was normal. Recurrent primary haemorrhage occurred 3 h post-operatively requiring immediate surgical intervention, removal of the inferior poles, precautionary throat packs, intubation and observation on the intensive treatment unit (ITU). Re-examination in theatre revealed a bleeding left superior pole that was under-run to achieve haemostasis and the patient returned to ITU. Hypertensive episodes were noted in the emergency department and intraoperatively including one recording >200 mm Hg. Haemostasis was eventually achieved once the blood pressure was adequately controlled. A slow wean of steroids was also instigated and the patient was managed on a surgical ward for 2 weeks post-tonsillectomy.
Department of ENT, West Middlesex University Hospital, London, Middlesex, UK.
Richard
R
Fox
Department of ENT, West Middlesex University Hospital, London, Middlesex, UK.
Kiran
K
Varadharajan
Department of ENT, West Middlesex University Hospital, London, Middlesex, UK.
Bhavesh
B
Patel
Department of ENT, West Middlesex University Hospital, London, Middlesex, UK.
Issa
I
Beegun
D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000379:methods; D000731:Androstanes / Q000009:adverse effects*; D004300:Doping in Sports; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D007328:Insulin / Q000009:adverse effects*; D008297:Male; D058573:Performance-Enhancing Substances / Q000009:adverse effects; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D035583:Rare Diseases; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D014068:Tonsillectomy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome
D000731:Androstanes; D007328:Insulin; D058573:Performance-Enhancing Substances