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Spontaneous tonsillar hemorrhage managed with emergency tonsillectomy in a 21-year-old man: a case report.

Vlastarakos PV, Iacovou E - J Med Case Rep (2013)

Bottom Line: Our patient was discharged the next day.The histology of the excised tonsil was suggestive of a benign non-specific ulcer, on a background of chronic non-specific tonsillitis.The tonsillar blood supply comes from branches essentially approaching the tonsil from underneath its body.

View Article: PubMed Central - HTML - PubMed

Affiliation: ENT Department, Lister Hospital, Coreys Mill Lane, Stevenage, Hertfordshire SG1 4AB, UK. pevlast@hotmail.com.

ABSTRACT

Introduction: Spontaneous tonsillar hemorrhage is defined as continuous bleeding for more than one hour, or more than 250mL of blood loss regardless of the duration of bleeding. It is an often under-diagnosed and under-reported complication of acute or chronic tonsillitis, with controversial management. We suggest that an emergency tonsillectomy should be performed as first-line treatment for this potentially life-threatening condition on the basis of the relevant anatomy.

Case presentation: A 21-year-old Caucasian British man was referred to the ear, nose and throat emergency service at our facility because of profuse tonsillar hemorrhage, with no history of tonsillectomy. Our patient had been experiencing right-sided swallowing discomfort for five days. On examination, blood spurting from the body of the right tonsil was seen, which was not manageable conservatively. Our patient was taken to an operating theatre, with his pre-operative hemoglobin having dropped by three units within three hours. The bleeding was not controlled by superficial cautery using bipolar diathermy, and a right tonsillectomy with meticulous hemostasis was performed. Our patient was discharged the next day. The histology of the excised tonsil was suggestive of a benign non-specific ulcer, on a background of chronic non-specific tonsillitis.

Conclusions: The tonsillar blood supply comes from branches essentially approaching the tonsil from underneath its body. Ear, nose and throat surgeons and accident and emergency doctors need to be aware that an episode of spontaneous tonsillar hemorrhage is not likely to be controlled conservatively, because the source of bleeding requires removal of the tonsil to be accessed. Hence, performing a tonsillectomy seems a reasonable first-line treatment in such cases.

No MeSH data available.


Related in: MedlinePlus

The blood supply to the palatine tonsil (modified from Wikipedia).
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Figure 2: The blood supply to the palatine tonsil (modified from Wikipedia).

Mentions: The palatine tonsil lies in a triangular space, bounded by the glossopalatine (anterior) and pharyngopalatine (posterior) arches. The blood supply of the tonsil comes from the tonsillar branch of the facial artery (main supply inferior pole), the tonsillar branches of the ascending palatine branch of the facial artery and the ascending pharyngeal branch of external carotid artery (posteriorly), the tonsillar branch of the dorsal lingual branch of the lingual artery (anteriorly), and the lesser palatine artery from the descending palatine branch of the maxillary artery (superior pole) (FigureĀ 2). All these branches approach the tonsil from behind (that is, underneath its body), with the exception of the dorsal lingual branch, which penetrates the tonsil anteriorly, but not from the medial (visible) border.


Spontaneous tonsillar hemorrhage managed with emergency tonsillectomy in a 21-year-old man: a case report.

Vlastarakos PV, Iacovou E - J Med Case Rep (2013)

The blood supply to the palatine tonsil (modified from Wikipedia).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750276&req=5

Figure 2: The blood supply to the palatine tonsil (modified from Wikipedia).
Mentions: The palatine tonsil lies in a triangular space, bounded by the glossopalatine (anterior) and pharyngopalatine (posterior) arches. The blood supply of the tonsil comes from the tonsillar branch of the facial artery (main supply inferior pole), the tonsillar branches of the ascending palatine branch of the facial artery and the ascending pharyngeal branch of external carotid artery (posteriorly), the tonsillar branch of the dorsal lingual branch of the lingual artery (anteriorly), and the lesser palatine artery from the descending palatine branch of the maxillary artery (superior pole) (FigureĀ 2). All these branches approach the tonsil from behind (that is, underneath its body), with the exception of the dorsal lingual branch, which penetrates the tonsil anteriorly, but not from the medial (visible) border.

Bottom Line: Our patient was discharged the next day.The histology of the excised tonsil was suggestive of a benign non-specific ulcer, on a background of chronic non-specific tonsillitis.The tonsillar blood supply comes from branches essentially approaching the tonsil from underneath its body.

View Article: PubMed Central - HTML - PubMed

Affiliation: ENT Department, Lister Hospital, Coreys Mill Lane, Stevenage, Hertfordshire SG1 4AB, UK. pevlast@hotmail.com.

ABSTRACT

Introduction: Spontaneous tonsillar hemorrhage is defined as continuous bleeding for more than one hour, or more than 250mL of blood loss regardless of the duration of bleeding. It is an often under-diagnosed and under-reported complication of acute or chronic tonsillitis, with controversial management. We suggest that an emergency tonsillectomy should be performed as first-line treatment for this potentially life-threatening condition on the basis of the relevant anatomy.

Case presentation: A 21-year-old Caucasian British man was referred to the ear, nose and throat emergency service at our facility because of profuse tonsillar hemorrhage, with no history of tonsillectomy. Our patient had been experiencing right-sided swallowing discomfort for five days. On examination, blood spurting from the body of the right tonsil was seen, which was not manageable conservatively. Our patient was taken to an operating theatre, with his pre-operative hemoglobin having dropped by three units within three hours. The bleeding was not controlled by superficial cautery using bipolar diathermy, and a right tonsillectomy with meticulous hemostasis was performed. Our patient was discharged the next day. The histology of the excised tonsil was suggestive of a benign non-specific ulcer, on a background of chronic non-specific tonsillitis.

Conclusions: The tonsillar blood supply comes from branches essentially approaching the tonsil from underneath its body. Ear, nose and throat surgeons and accident and emergency doctors need to be aware that an episode of spontaneous tonsillar hemorrhage is not likely to be controlled conservatively, because the source of bleeding requires removal of the tonsil to be accessed. Hence, performing a tonsillectomy seems a reasonable first-line treatment in such cases.

No MeSH data available.


Related in: MedlinePlus