Question

A post-tonsillectomy child was lying in the ward. He started bleeding in the ward. Which of the following should be done?

• A. Take to OT, remove the clot and re-ligation
• B. Take to OT and pressure packing
• C. Cautery
• D. Conservative management

Hint:

Post-tonsillectomy bleeding in the ward within 24 hours is reactionary haemorrhage; the definitive management requires going to OT to identify and secure the bleeding vessel.

Answer 1

The Correct Option is A

Step 1: Classify the type of bleeding. Bleeding after tonsillectomy is classified by timing:
- Primary (reactionary) haemorrhage: Occurs within 24 hours of surgery. The child is still in the ward -- this fits reactionary haemorrhage.
- Secondary haemorrhage: Occurs after 24 hours (usually day 5-10) due to infection and sloughing of the slough.

Step 2: Understand management by type.
- Primary bleeding in the ward = Reactionary haemorrhage. The slip of a ligature is the most common cause. Management: take to OT, remove the clot (to expose the bleeding vessel), and re-ligate.
- Pressure packing and cautery are used for primary (immediate intraoperative) bleeding, not reactionary bleeding in the ward.
- Conservative management is used only for secondary haemorrhage that is minor (e.g., salt water gargling).

Step 3: Why must the clot be removed? A clot in the tonsillar fossa may be masking significant ongoing bleeding. Removal of the clot and re-ligation of the bleeding vessel under direct vision in the OT is the definitive treatment for reactionary haemorrhage.

Conclusion: Post-tonsillectomy bleeding in the ward = reactionary haemorrhage. Management is to take the child to OT, remove the clot, and re-ligate the bleeding vessel.