Question:medium
A post-tonsillectomy child was lying in the ward. He started bleeding in the ward. Which of the following should be done?
A post-tonsillectomy child was lying in the ward. He started bleeding in the ward. Which of the following should be done?
Show 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.
Updated On: Jun 23, 2026
- Take to OT, remove the clot and re-ligation
- Take to OT and pressure packing
- Cautery
- Conservative management
Show Solution
The Correct Option is A
Solution and Explanation
Scenario analysis: Child in ward after tonsillectomy starts bleeding. Since the child is still in the ward (within 24 hours post-surgery), this is reactionary (primary) haemorrhage.
Types of post-tonsillectomy bleeding:
1. Primary (immediate intraoperative): managed with pressure packing or cautery
2. Reactionary (within 24 hours): managed by taking to OT, removing clot, and re-ligation
3. Secondary (after 24 hours, usually day 5-10): due to infection; managed conservatively if minor or surgically if severe
Why re-ligation in OT? Reactionary haemorrhage is usually due to slipping of a ligature. A clot may be sitting in the tonsillar fossa masking active bleeding. The clot must be removed under controlled OT conditions and the bleeding vessel re-ligated to achieve haemostasis.
Why not other options?
- Pressure packing/cautery: appropriate for primary intraoperative bleeding, not reactionary
- Conservative management: appropriate for minor secondary haemorrhage only
Answer: Take to OT, remove the clot, and re-ligation is the correct management of reactionary post-tonsillectomy haemorrhage. \[\boxed{\text{Take to OT, remove the clot and re-ligation}}\]
Types of post-tonsillectomy bleeding:
1. Primary (immediate intraoperative): managed with pressure packing or cautery
2. Reactionary (within 24 hours): managed by taking to OT, removing clot, and re-ligation
3. Secondary (after 24 hours, usually day 5-10): due to infection; managed conservatively if minor or surgically if severe
Why re-ligation in OT? Reactionary haemorrhage is usually due to slipping of a ligature. A clot may be sitting in the tonsillar fossa masking active bleeding. The clot must be removed under controlled OT conditions and the bleeding vessel re-ligated to achieve haemostasis.
Why not other options?
- Pressure packing/cautery: appropriate for primary intraoperative bleeding, not reactionary
- Conservative management: appropriate for minor secondary haemorrhage only
Answer: Take to OT, remove the clot, and re-ligation is the correct management of reactionary post-tonsillectomy haemorrhage. \[\boxed{\text{Take to OT, remove the clot and re-ligation}}\]
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