031 - Hybrid Operating Room: Interventional Radiology and Otolaryngology
Marian Gaballah, D.O. – Attending Pediatric Interventional Radiologist, Division of Interventional Radiology, Children's Hospital of Philadelphia; Ganesh Krishnamurthy, M.D. – Attending Pediatric Interventional Radiologist, Division of Interventional Radiology, Children's Hospital of Philadelphia; Anne Marie Cahill, MBBch, BAO – Attending Pediatric Interventional Radiologist, Division of Interventional Radiology, Children's Hospital of Philadelphia
Purpose: The purpose of this case report is to demonstrate a novel collaborative approach performed by interventional radiology and otolaryngology to control intractable hemorrhage, a rare complication seen post-tonsillectomy.
Material and Methods: We report the case of a 10-year-old female with an oral bleed four days post-tonsillectomy. The patient was emergently taken to the operating room by otolaryngology where she was found to have arterial bleeding in the right tonsillar bed. Attempts to cauterize this 3 mm vessel resulted in vessel retraction and worsening of the pulsating bleed, while clamping was unsuccessful due to insufficient vessel traction. The tonsillar fossa was packed while interventional radiology was consulted to perform embolization.
Results: The patient was transferred to the interventional radiology suite. With the otolaryngologist present to corroborate her evaluation of the bleeding site at the lower pole tonsillar bed, angiography of the external carotid artery revealed a normal branching pattern and caliber, with no focal blush to suggest active bleeding. Therefore, a catheter was advanced into the right facial artery branch of the external carotid artery. The otolaryngologist placed a metal marker near the site of bleeding to facilitate localization. The tonsillar branch of the right facial artery was subselected using a 2.5 F straight low flow microcatheter and a 0.018” shapable wire. Irregularity of the tonsillar branch was identified on angiography and two 0.018” x 0.05 cm straight Hilal coils (Cook Medical, Bloomington, IN) were deployed into the right tonsillar artery; subsequent angiography demonstrated successful coil deployment. No active bleeding via the mouth or on angiography occurred following embolization. The otolaryngologist packed the site and the patient was transferred to the pediatric intensive care unit.
Conclusions: This case was successfully navigated with a collaborative procedure performed by interventional radiology and otolaryngology, which allowed for localization of the site of bleeding and successful embolization.