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Post-tonsillectomy pseudoaneurysm: an underestimated entity?

Published online by Cambridge University Press:  18 September 2009

J P Windfuhr ,
A M Sesterhenn ,
G Schloendorff  and
B Kremer
J P Windfuhr*
Affiliation:
Department of ORL Malteser Krankenhaus St. Anna Duisburg, Germany
A M Sesterhenn
Affiliation:
Philipps University of Marburg, Marburg, Germany
G Schloendorff
Affiliation:
University Hospital of Aachen, Germany
B Kremer
Affiliation:
University Hospital Maastricht, The Netherlands
*
Address for correspondence: Dr Jochen P Windfuhr, Department of Otorhinolaryngology, Head and Neck Surgery, St Anna Hospital, Albertus Magnus Str 33, 47259 Duisburg, Germany. Fax: +49 203 755 1266 E-mail: jochen.windfuhr@malteser.de
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Abstract

Objective:

To identify patients undergoing arteriography to verify vascular complications of tonsillectomy, with an emphasis on pseudoaneurysm.

Patients and methods:

We undertook a retrospective analysis of the case records of 8837 patients who had undergone tonsillectomy between 1988 and 2004 at our institution, together with a review of expert reports written for professional boards and civil courts as well as personal experiences or communication. We also conducted a literature review using the PubMed database.

Results:

We identified seven cases with vascular abnormalities. In addition, we identified three cases of pseudoaneurysm formation, involving two children and one adult patient, with bleeding 21, 36 and 58 days after tonsillectomy. Successful management included embolisation (two patients) and revision surgery (one patient).

Conclusion:

Post-tonsillectomy pseudoaneurysm formation is extremely rare and unrestricted by age. Correct diagnosis depends largely on a high index of clinical suspicion. Delayed and repeated episodes of gushing haemorrhage with spontaneous cessation appear to be a significant clinical marker. Immediate arteriography, with simultaneous embolisation, is highly recommended. The lingual artery is the most commonly involved vessel.

Keywords

TonsillectomyPost-tonsillectomy HemorrhagePseudoaneurysmComplicationEpisodic Bleeding

Information

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 1 , January 2010 , pp. 59 - 66
Copyright
Copyright © JLO (1984) Limited 2009

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