Post-tonsillectomy hemorrhage

Background

• Occurs in 0.5-10% of tonsillectomies
• Most common on POD 5-7
• Highest incidence in 21-30 year olds
• Lowest in <6 year olds

Clinical Features

• Hemoptesis

Differential Diagnosis

• Post-op pain

Evaluation

• Physical exam (do NOT remove any clots)

Management

Work-Up

• CBC
• T+S or T+C

Management

• ENT consult: Always, rebleeding is common and half of presentations require surgical management
• Airway management (anticipate difficulty and have surgical back up)
• IV, O2, Monitor, NPO, upright position
• Can try direct pressure with tonsillar pack or gauze infused with lido with epi on a long clamp
• If stable, no active bleeding, and clot is present- do not remove the clot.

See Also

Pharyngitis