gms | German Medical Science

78. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V.

Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V.

16.05. - 20.05.2007, München

Excessive post-tonsillectomy hemorrhage with and without lethal outcome in Germany

Meeting Abstract

  • corresponding author Jochen P. Windfuhr - Department of Otorhinolaryngology, Malteser Krankenhaus St.Anna, Duisburg, Germany
  • Georg Schlöndorff - Praxis für Hals-, Nasen-, Ohren-Krankheiten, Aachen, Germany
  • Diwa Baburi - Klinik für Innere Medizin, Med. Zentrum Kreis Aachen, Betriebsteil Bardenberg, Würselen, Germany
  • Albrecht Wienke - Rechtsanwaltskanzlei, Köln, Germany
  • Bernd Kremer - Department of Otorhinolaryngology, University Hospital, Maastricht, Netherlands

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. 78th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. Munich, 16.-20.05.2007. Düsseldorf, Köln: German Medical Science; 2007. Doc07hno080

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/hno2007/07hno080.shtml

Veröffentlicht: 8. August 2007

© 2007 Windfuhr et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: Fatalities following tonsillectomy are rarely discussed in the literature and only few data exist. This study was initiated to evaluate the incidence and clinical features of excessive post-tonsillectomy hemorrhage with and without lethal outcome in Germany.

Method: Personal communication and a questionnaire published nationwide in „HNO-Mitteilungen“ served as the source of our data analysis. Colleagues were encouraged to send case reports that matched our search criteria.

Results: A total of 92 cases could be collected of whom 44 were children. All cases did occur between 1980 and 2004 with one exception having occurred in 1974. There were 22 cases with lethal outcome (32%), of whom 15 (68%) had experienced prior episodes of bleeding with spontaneous cessation. 69 patients experienced excessive post-tonsillectomy hemorrhage requiring ligature of the external carotid artery. 60 of these 69 patients had experienced prior episodes of bleeding with spontaneous cessation. However, survival was accompanied with neurologic deficits in 8 of these 69 patients (hemiplegia, apallic syndrome) of whom 6 had experienced prior episodes of bleeding as well.

Conclusion: It appears, that spontaneous cessation of post-tonsillectomy hemorrhage may precede excessive hemorrhage. Therefore it remains our policy to admit any patient presenting with postoperative bleeding following tonsillectomy regardless the intensity and the the day post-tonsillectomy hemorrhage occurs. Arteriography should be considered for those cases, in whom repeated episodes of post-tonsillectomy hemorrhage do occur. Experts should note, that lethal outcome due to excessive post-tonsillectomy hemorrhage may occur fatefully despite optimal medical treatment. Our study does not support the estimated rate of 1 lethal outcome after 27.000 as stated in 1970 by Pratt [1]. However, the data collection is not accurate enough to make final conclusions concerning the true incidence of fatalities following tonsillectomy. Therefore, we suggest a nationwide, systematic research program.


References

1.
Pratt LW. Tonsillectomy and adenoidectomy: mortality and morbidity. Trans Am Acad Ophthalmol Otolaryngol. 1970;74:1146-54.
2.
Windfuhr JP. Lethal post-tonsillectomy hemorrhage. Auris Nasus Larynx. 2003;30:391-6.
3.
Windfuhr JP. Indications for interventional arteriography in post-tonsillectomy hemorrhage. J Otolaryngol. 2002;31:18-22.