Management of Tonsillectomy bleeding


By

Dr. T. Balasubramanian M.S. D.L.O.

Haemorrhage is one of the most important complication of tonsillectomy surgery.  It can be classified thus:

Primary bleeding: Is bleeding which occurs on the table during surgery.  This is more extensive and common in cases which has not been prepared properly.  To avoid this complication tonsillectomy should not be performed during acute phase of tonsillar infection.  Injury to para tonsillary vein is the other common cause for primary haemorrhage.  Diathermy can be used to stop active bleeding on the table.

Reactionary bleeding:   This complication occurs during the immediate post operative period.  The cause for this complication could be:
1. Wearing off of the hypotensive effects of anaesthetic drugs

2. Slippage of ligature during the immediate post op period

Blood transfusion must be contemplated in the case of excessive blood loss.  If  the clot enlarges in size progressively then the patient must be shifted to the theatre and the bleeding vessel must be ligated immediatly.

Secondary bleeding:  Occur during the first week following surgery.  This complication is caused by secondary infection.  Antibiotics can be commonly used to treat this complication.    In resistant cases pillar suturing can be resorted to.

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