Post‑tonsillectomy bleed
Overview
Post‑tonsillectomy haemorrhage ranges from minor oozing to life‑threatening bleeding with airway compromise. It is a recognised complication of tonsil surgery and may require readmission or return to theatre.
Emergency clinicians must prioritise airway and haemodynamic stabilisation, call senior/ENT/anaesthetics early and follow local massive haemorrhage / ENT escalation pathways (NICE; RCEM; Resuscitation Council UK).
Classification
> 24 hours (commonly postoperative days 5-10) | Sloughing of the eschar, local infection, trauma (e.g. solid food), NSAIDs, idiopathic; usually venous oozing but can be arterial (NICE) |
Relevant anatomy and implications
- Most bleeds are venous - commonly from the external palatine (peritonsillar) veins draining the lateral tonsillar region into the facial vein.
- Arterial bleeding may originate from the tonsillar branch of the facial artery (inferior pole) and is more likely to be brisk and require surgical control.
- Surgical technique (cold steel, diathermy, coblation, etc.) influences secondary haemorrhage risk; surgeons should counsel patients accordingly (NICE).
Presentation and initial assessment
- Spectrum: blood‑streaked saliva to active torrential haemorrhage. Red flags include airway compromise, ongoing brisk pulsatile bleeding, haemodynamic instability, and significant blood loss or transfusion requirement.
- Rapid assessment: follow ABC with an early airway plan; keep the patient upright and calm; provide continuous monitoring (SpO2, ECG, BP).