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.
