A 7-year-old child with recurrent tonsillitis has undergone tonsillectomy. On post-operative day 8, he presents with active bleeding from the tonsillar fossa. This is classified as which type of post-tonsillectomy hemorrhage, and what is its most common cause?

• A Primary hemorrhage; inadequate hemostasis
• B Reactionary hemorrhage; vasodilatation as anesthesia wears off
• C Secondary hemorrhage; retained suture material
• D Secondary hemorrhage; infection leading to sloughing of eschar ✓

Explanation

Post-tonsillectomy hemorrhage is classified as: primary (within 24 hours, due to inadequate intraoperative hemostasis), reactionary (24 hours to 7 days, due to clot lysis or vasodilatation), and secondary (after 7 days, most commonly on days 5–10, due to infection and sloughing of the fibrinous eschar covering the tonsillar bed). Secondary hemorrhage is the most common type overall in many series and is caused by bacterial infection (Streptococcus/Pseudomonas) dissolving the protective eschar. Day 8 bleeding is clearly secondary hemorrhage.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.