Is Bleeding After a Tonsillectomy an Emergency?

Serious Post-Tonsillectomy Symptoms

Looking at tonsil beds; 8 hours after surgery.
Looking at tonsil beds; 8 hours after surgery.. "Tonsillectomy left fosa" by Bobjgalindo|Roberto J. Galindo, MD - Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Tonsillectomy_left_fosa.jpg#/media/File:Tonsillectomy_left_fosa.jpg

Bleeding After A Tonsillectomy

Bleeding after a tonsillectomy is considered an emergency due to the close proximity of major arteries to the tonsils. Many people have their tonsils out every day in the United States and most do just fine, however, post-operative bleeding can occur in a very variable frequency depending on the physician, technique used, and nature of the procedure. Complications from a tonsillectomy vary with the worst complication being death.

In response to a blog I wrote about a 5-year-old child who died from post-operative bleeding after a tonsillectomy I received this terrifying comment:

". . . I read this while looking on the internet. My 2-year-old died the same way. . .hers was the lingual artery, a branch of the carotid. There was nothing I could do to stop the blood… I was helpless. People do need to understand that while this is a rare complication, it can happen."

Checking for Post-Operative Bleeding

Tonsillectomies are some of the most common surgeries in the world and while rare, bleeding after a tonsillectomy should be taken seriously. Signs of bleeding after a tonsillectomy include:

  • bright red blood coming from the mouth or nose
  • tasting blood in your mouth - a metallic taste
  • frequent swallowing
  • spitting out bright red blood
  • vomiting bright red or old blood - old blood is dark brown in color and is sometimes described as looking like coffee grounds

    When Does Post-Operative Bleeding Occur?

    Bleeding after a tonsillectomy is most likely to occur right after surgery or about a week later when the scabs come off. However, bleeding can occur at any point in the recovery process (around 2 weeks). You may hear your doctor refer to primary hemorrhage or secondary hemorrhage.

    All this refers to is the length of time that passed before bleeding occurred:

    • primary hemorrhage is bleeding that occurs within 24 hours after a tonsillectomy
    • secondary hemorrhage is bleeding that occurs more than 24 hours after a tonsillectomy

    What You Can Do?

    If there is significant bleeding immediately after surgery, you may return back to the OR to have additional cauterization. If significant bleeding occurs or your doctor suspects bleeding problems, you may be kept in the hospital overnight. However a tonsillectomy rarely requires hospitalization and is usually considered an "outpatient procedure".

    If you suspect any of the signs listed above, you may wish to look at the tonsil beds. You can do this using a flashlight and a tongue depressor or popsicle stick. Depending on how long it's been since you had surgery, your tonsil beds should look white or dark brown. The picture at the top of this page is a good depiction of what the tonsil beds look like 8 hours after a surgery. If they are covered with bright red blood or you see bright red streaks running down the back of the throat you should seek medical attention immediately.

    It is not uncommon to swallow blood during a tonsillectomy and then vomit old blood the day of surgery. If this happens you should try to visualize the tonsil beds. If you cannot see them, if you are uncomfortable doing this, if you have doubts, or if you see bright red blood contact your doctor right away. In most cases bleeding after a tonsillectomy can be stopped by cauterizing the tonsil beds but it is important to get emergency medical treatment If you begin bleeding after a tonsillectomy or suspect you might be bleeding.

    Other Potential Complications From A Tonsillectomy

    Bleeding is the most common and severe complication to a tonsillectomy. There are, however, other complications that you should look out for and contact a physician if they are noticed;

    • difficulty breathing
    • dehydration
    • infection

    Generally speaking, tonsillectomies are very safe procedures. However due to the risks involved in having a tonsillectomy, it is important for you to be informed and know how to check for bleeding tonsils to prevent the worst complications, as these can occur.

    Sources:

    Liu, J.H., Anderson, K.E., Willging, J.P., Myer III, C.M., Shott, S.R., Bratcher, G.O. & Cotton, R.T. (2001). Posttonsillectomy Hemorrhage: What Is It and What Should Be Recorded? Arch Otolaryngol Head Neck Surg. 127(10):1271-1275. doi:10.1001/archotol.127.10.1271.

    Messner, A.H. (2015). Tonsillectomy (with or without adenoidectomy) in children: Postoperative care and complications. Accessed on January 27, 2016 from http://www.uptodate.com (subscription required).

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