Case of fatal secondary luemorrhage on the eighth day following the removal of adenoid vegetations. Patient, who was eleven years old, gave no history of a bleeder, but it was noticed the blood from the first bleeding was only partly clotted. Wallace Preble (Boston Med. and Surg. Jour., May 19, '98).
Three cases of luemorrhage following adenoid operations. Personal operating experience on these growths of seven years before a complete realization of what dangerous consequences could ensue. Surgical procedure in these cases. The adenoids were removed with the Gott stein knife under cocaine anxstlicsia, Martin (Laryngoscope, July, '99).
Case in which a pharyngeal tonsil the size of a walnut was removed from the pharynx of a boy 10 years of age. Severe limmorrhage occurred a few hours later, and the patient died four days after the operation despite all that could be done.
The patient was hmophilic. Richard Sachs (Jour. of Laryn., etc., Feb., 1900).
An instrument devised to take the place of the curette, a post-nasal guillo tine, has been devised by the writer. It is constructed in such a manner as to accomplish all that is claimed for the curette without causing injury to the organs adjacent to the adenoid tumor requiring removal. Another advantage claimed for it is simplicity of technique. In introducing the guillotine into the naso-pharyngeal space no difficulty is ex perienced, the curved blade being carried into the vault in the same manner as the curette. By keeping the instrument in the median line of the roof and exer cising such pressure as will force the blade -upward and forward the tumor is brought within its grasp and readily ex cised by drawing from before backward the guarded knife.
The question arises: will hremorrhage follow an operation with the guillotine MOTC readily than when the cutting for ceps or the curette is employed? Experi ence teaches that it does not. hxmo philiacs hremorrhage is always liable to occnr regardless of the method employed; simple palpation of the adenoid tissue has been followed by fatal bleeding (Dela van). Secondary Inemorrhages of a violent nature have taken place after the removal of the post-nasal adenoid growths.
[Two eases of this character are re called in boys, respectively, 8 and 9 years of age. Apart trom the adenoid
disease they 1% cre apparently well. One week after the operation (by Gottstein's curette) persistent bleeding set in, which could only be brought under control by forcibly tamponing the post-nasal space. Hinkle reports a case of luemor. rhage of an alarming- character controlled .1.1.,.,/,ntly by appl3ing to the bleeding •urf.ite the g y subst.inee formed by t‘c ,4.mbination of antifebrin and tannic .t 1.1 in :whitlow JAcon E. SCIIADI.E.] ls neurrenee liable to take place after the rc moral of adenoids? Not as a rule, previd(d the operation has been skillfully dom. and complete removal accomplished.
Recurrence of adenoid vegetations after their removal is more frequent than is suppos,ed: thus necessity of com removal. F. E. IIopkins (N. Y. Med. Jour., Jan. 26, '95).
The recurrence of the growths in young children sometimes witnessed is due to the greater difficulty in effecting complete removal in them and the greater predisposition to the prAifera tion of lymphoid tissue under slight provocation. Dundas Grant (Jour. of Laryng., Aug., '97).
When at all possible it is better to re move adenoid growths without the use of a general anwsthetic, as there can be no doubt that anwsthesia adds an element of risk to the operation. Locally applied, cocaine is invaluable; it renders the pres ence of instruments tolerable and the op eration quite easy, especially if the palate can be retracted with either hook or tape. But the dexterous operator generally requires no auxiliary assistance (palate retraction or naso-pharyngeal illumina- , tion), and contents himself with sunlight directed into the throat, and perhaps of the index finger to guide the instrument into the naso-pharynx.
When a general anmsthetic is used the patient should be placed in bed or on a couch with the head on a level with the body, which position should be main tained—after the patient has been raised or turned to expel the blood from the naso-pharynx—until the immediate ef fects of the ansthetic have passed off. Sometimes retching and vomiting of blood that was swallowed occur after the operation.