Treatment of Delayed Bleeding after Adenotonsillectomy with Embolization and Ligature Vascular with Cervical Surgical Study

Introduction: Bleeding is the most worrisome complication of adenotonsillectomy, with pseudoaneurysms and arterial dissections been considered serious causes of it. The possible therapies are local maneuvering, embolization, and arterial ligature; the latter being more effective measures. Objectives: The aim of the study is to describe the therapeutic possibilities for severe delayed bleeding after adenotonsillectomy in children through clinical case.

Resumed Report: GHSS, a 7-year-old boy who underwent adenotonsillectomy uneventfully. On the 7th postoperative day, with reporting of the oral bleeding in the past 2 days, he was admitted without active bleeding. After 6 hours, massive hemorrhage in the lower pole of the left palatine tonsil region began, with local raffia being performed. The next day was embolized with PVA particles with suggestive lesions of pseudoaneurysm in the ascending pharyngeal artery. On the 10th day after embolization, a new massive hemorrhage in the same region was presented, which performed local raffia and ligature of both external carotid arteries. On immediate postoperation, another bleeding was noticed and the patient went to the surgical center to ipsilateral neck study with ligature of some small vessels. Palatine tonsil hemostasis was reinforced with raffia and surgical glue. The patient progressed well and was discharged in 2 weeks.

Conclusion: The rebleeding after ligature of the external carotid may have been caused by vascular anomaly, although none has been found during the surgery. Even though the embolization has not been effective in this case, it remains as an effective and safe diagnostic method with less morbidity and the external carotid ligature is still a valuable option in severe cases.