Otolaryngology Case Reports · Published 2026-07-16 · DOI 10.1016/j.xocr.2026.100762
Alina Zgardau, Justin Shapiro, Gopakumar Sudhakaran Nair, Sachin Pandey, Murad Husein, Josee Paradis, Peng You, Julie E. Strychowsky
Background: Although severe primary arterial hemorrhage during intracapsular tonsillectomy is rare, these cases illustrate that it may still occur. The role of endovascular embolization in this setting has been only sparsely described. Case presentation: We report two otherwise healthy pediatric patients who underwent Coblation intracapsular tonsillectomy and developed disproportionately brisk hemorrhage arising from the inferior tonsillar pole. In the first case, left inferior pole bleeding was refractory to pressure, topical hemostatic packing, bipolar cautery, suction cautery, and vascular clipping, prompting immediate transfer from the operating room to interventional neuroradiology. Angiography demonstrated hemorrhage from branches of the external carotid circulation, and embolization achieved definitive hemostasis. In the second case, right inferior pole bleeding was initially controlled intraoperatively with pressure, hemostatic packing, bipolar cautery, intravenous tranexamic acid, and intubation for airway protection, but recurred several hours later after coughing; urgent lingual artery embolization was required. Both patients remained intubated overnight for airway protection and were extubated the following day without neurologic or local complications. Conclusion: Although Coblation intracapsular tonsillectomy is generally associated with a low hemorrhage burden, life-threatening primary or early recurrent bleeding can still occur, particularly from inferior pole branches of the external carotid system. These cases highlight the need for early recognition of unusually brisk inferior pole hemorrhage, prompt escalation beyond repeated transoral maneuvers when standard hemostasis fails, and early involvement of interventional neuroradiology.
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Zgardau, A., Shapiro, J., Nair, G., et al. (2026). Inferior pole arterial hemorrhage during coblation intracapsular tonsillectomy requiring endovascular embolization in two pediatric cases. Otolaryngology Case Reports. https://doi.org/10.1016/j.xocr.2026.100762