الفهرس 
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Abstract
Post tonsillectomy secondary hemorrhage is the most common complication after tonsillectomy operation.
It is defined as bleeding from the site of operation occurs(>24h)after operation.
The main predisposing factor of post tonsillectomy secondary hemorrhage is secondary bacterial infection.
The main causative organism in the post tonsillectomy secondary infection are staphylococcus and streptococcus organisms these microorganisms are the most encountered bacteria in the throat infection .
In this study there are different age groups who represent (33.3%) (20 cases ) aged from 5 -15 years old, (21.7% ) ( 13 case ) aged from 15 -25 years old, (31.77% ) (19 case ) aged from 25-35years old and(13.3%) (8cases) above 35 years old .
So the difference in age is not significant.
The difference in sex is insignificant between the patient but females slightly higher than male.
The patient that not follow the full antibiotic course before and after operation increase their incidence for occurrence of post tonsillectomy secondary hemorrhage due to secondary bacterial infection .
The patients who are not follow up the food instruction represent ( 66.7%) ( 40 cases ) and who are follow up it represent ( 33.3 % ) ( 20 case).
Technique and method of tonsillectomy operation done reflect that the(58.3 % ) ( 35 case ) were done by using bipolar diathermy and ( 41.7 % ) ( 25 case ) by cold dissection and this represent that increase incidence of post tonsillectomy secondary hemorrhage in operation done using bipolar diathermy ,but the difference is not significance.
More common site of bleeding point in post tonsillectomy secondary hemorrhage are lower tonsillar pole together with tonsillar bed which represent ( 58.3 % ) (35cases) ,bleeding from lower pole alone represent ( 25%)(15cases) bleeding from tonsillar bed alone represent (10 cases) (16.75%)(10 cases).
Bleeding after tonsillectomy may be unilateral or bilateral;Unilateral bleeding represent (76.6%) (46 cases) and bilateral bleeding represent (23.3%) (14 cases).Bilaterality of bleeding may indicate systemic cause of hemorrhage.
The main important investigations that done in cases of post tonsillectomy secondary hemorrhage are:
1-prothrombin time and concentration which reflect presence of blood disease.The percentage of abnormal prothrombin time and concentration is (1.7%) (1case).
2- complete blood picture which show Hb percentage which range from 12-10gm/dl represent (48.3%) (28cases),10-9gm/dl represent (38.3%) (23cases) ,9-7gm/dl represent (11.7%) (7cases),and below than 7gm/dl represent (1.7%) (1case) who need blood transfusions.
3-TLC to determine the presence of infection. Elevated TLC represent (71.7%) (43cases).
4-Abnormal liver function test may be the cause of bleeding these represent (8.3%) (5cases).
The method of bleeding control in post tonsillectomy secondary hemorrhage are life saving conservative method in the form of :
• Diluted H2O2 gargle.
• I.V fluids.
• Umbrella of broad sepetrum antibiotic.
• Hemostatic drugs Dicynon, kapron, Hemacune .
Conservative method is enough alone to stop bleeding in ( 66.7% ) ( 40 cases) In some cases the conservative treatment is failed to control bleeding so surgical interference were done in(31.7%) (19 cases).
In very sever bleeding which not stopped by ligation and suture site of bleeding point ligation of external carotid artery which was done in only one case (1.7%)(1case).