Recurrent Post Tonsillectomy Hemorrhage: An Alarming Complication

Objective: The aim of this study was to highlight the diagnosis and treatment of vascular injury as a rare cause of delayed resistant post-tonsillectomy hemorrhage, and the importance of both treatment modalities (surgical ligation and endovascular embolization). Patients and Methods: This was a retrospective study of 11 patients who experienced delayed resistant posttonsillectomy hemorrhages (DRPTHs). There were seven males and four females, with their ages ranging between four and seven years, and a mean age at presentation of four years old. Seven patients were treated using surgical ligation, while five underwent endovascular embolization. Results: All 11 cases had idiopathic vascular abnormalities. Four of the patients developed pseudo aneurysms of the lingual artery, with one mainly in the linguofacial trunk. The other five patients had direct injuries to the walls of the lingual (three patients) and facial (two patients) arteries. Bleeding occurred between the 11th and 28th days after the tonsillectomies, and successful management included embolization (five patients) and surgery (six patients). Conclusion: DRPTH is extremely rare, and deep suturing of the lower pole of the tonsil is the probable cause of the vascular injury. Early referral for embolization or open surgical exploration and ligation of the bleeding vessel is mandatory.