Publikationsserver der RWTH Aachen University
Lebensbedrohliche und tödliche Tonsillektomie-Nachblutungen
Abstract
dc:descriptionLife-threatening and severe post-tonsillectomy hemorrhage (PTH) is an uncommon complication, which hasn’t been described sufficiently in the literature. This study was undertaken to describe serious PTH and develop advices for the management of emergency cases so as surgical and angiographic treatment of PTH and preliminary bleeding. A nationwide collection of cases was performed based on personal communication, expert reports to lawsuits and professional boards and case reports received after a plea published in a professional national journal. We included cases accompanied by hemorrhagic shock and resuscitation, requiring ligature of the external carotid artery and its branches or angiography with embolization and at least one preliminary bleeding. We collected 112 cases (29 lethal) with 54 children, 53 adults and 5 with unknown age. The analysis of these cases resulted in a new disease pattern that can not be ranged in the category of secondary PTH. Important aetiologic factors are the arrosion of vessels by necrotisizing infections, vessel aberrations or iatrogenic reasons. We differentiate two different types of bleeding: the mass bleeding, which causes a life-threatening hemorrhagic shock and the preliminary bleeding as a warning sign for an upcoming mass bleeding. Unexpected delayed PTH is to be considered. 43 patients experienced PTH after 10 days, 71,7% of PTH occurred after discharge. For the right treatment you need to make the right diagnosis by the right interpretation of the warning signs. If a severe PTH is suspected monitoring of vital sings is indicated. An active mass bleeding has to be stopped immediately, in case of need by digital compression. If the decision is made for the ligature of the external carotid artery a complete dissection of the common carotid artery, internal carotid artery and external carotid artery is recommended to exclude aberrant vessels. If the bleeding cannot be stopped the cause might be an atypical course of the vessel. Now the angiographic exploration of both common carotid arteries with the subsequent ligature or embolization is indicated. Life-threatening and lethal PTH is an uncommon and independent clinical picture. It is a rarity in the doctor’s daily routine, so that many of them never experienced severe PTH. Usually there is made no difference between “normal” PTH and the described mass bleedings. This is why doctor’s are often accused of an error of treatment. But even under optimal treatment conditions success is not guaranteed. Seconds are deciding so that the whole clinical picture is a fateful process.
Degree
thesis:*- Grantor dc:publisher
- Publikationsserver der RWTH Aachen University
- Year dc:date
- 2009
Author and committee
dc:creator, dc:contributor.*- Author dc:creator
-
- Baburi, Diwa
- Contributors dc:contributor
-
- Schlöndorff, Georg
Subjects
dc:subject × 13Rights
dc:rights- Statement dc:rights
-
- info:eu-repo/semantics/openAccess
- Language dc:language
- ger