Abstract
Abstract
Background
The majority of postoperative complications of tonsillectomy are bleeding. However, massive cerebral infarction following haemostasis is a very rare and serious complication and has rarely been reported clinically.
Case presentation
We performed a left tonsillectomy on a patient with chronic tonsillitis. After that, active bleeding was found under the tonsillar fossa, so an exploratory hypopharyngeal haemostasis was performed. However, the bleeding worsened intraoperatively, so the patient was converted to a cervical angiographic embolization. The interventional procedure was completed successfully without an ectopic embolic event. After the procedure, the patient was transferred to the intensive care unit (ICU) and was diagnosed with acute massive cerebral infarction in the left cerebral hemisphere after awakening symptoms combined with cranial computed tomography angiography (CTA) results. Symptomatic treatment such as sedation and analgesia, dehydration to lower intracranial pressure, and maintenance of respiratory and circulatory stability was then administered. After treatment, the patient’s condition stabilized and he was transferred to the rehabilitation physiotherapy unit for rehabilitation.
Conclusion
Post-tonsillectomy haemorrhage can be augmented with a carotid arteriogram to clarify whether the tonsillar fossa is at a safe distance from the posterior internal carotid artery. Furthermore, interventional haemostasis can also be performed as early as possible to reduce the incidence of complications in cases of persistent post-tonsillectomy bleeding.
Publisher
Springer Science and Business Media LLC
Subject
Neurology (clinical),General Medicine
Reference5 articles.
1. Mitchell RM, Parikh SR. Hemostasis in Tonsillectomy. Otolaryngol Clin North Am. 2016 Jun;49(3):615–26.
2. Osguthorpe JD, Adkins WY Jr, Putney FJ, Hungerford GD. Internal carotid artery as source of tonsillectomy and adenoidectomy hemorrhage. Otolaryngol Head Neck Surg. 1981;89(5):758–62.
3. Dong FL, Su LZ, Luo ZY, Jiang XZ. Angiographic embolization treatment of tonsillar artery pseudoaneurysm causing recurrent hemorrhages after tonsillectomy: a case report. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Jun 7;55(6):620–622.
4. Gagnier JJ, Kienle G, Altman DG, et al. CARE Group. The CARE guidelines: consensus-based clinical case reporting guideline development. Headache. 2013;53(10):1541–7.
5. Statham MM, Myer CM 3rd. Complications of adenotonsillectomy. Curr Opin Otolaryngol Head Neck Surg. 2010 Dec;18(6):539–43.