{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T11:05:54Z","timestamp":1753355154508,"version":"3.40.4"},"reference-count":6,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2014,10,26]]},"abstract":"<jats:p>A 30-year-old male body builder and androgenic-anabolic steroid and insulin abuser was admitted for day case elective tonsillectomy (bipolar). He returned with primary post-tonsillectomy haemorrhage 18\u2005h after the operation and required bipolar cautery to the multiple small bleeding points in the right and left tonsillar fossa. Thorough coagulation screen was normal. Recurrent primary haemorrhage occurred 3\u2005h post-operatively requiring immediate surgical intervention, removal of the inferior poles, precautionary throat packs, intubation and observation on the intensive treatment unit (ITU). Re-examination in theatre revealed a bleeding left superior pole that was under-run to achieve haemostasis and the patient returned to ITU. Hypertensive episodes were noted in the emergency department and intraoperatively including one recording &gt;200\u2005mm\u2005Hg. Haemostasis was eventually achieved once the blood pressure was adequately controlled. A slow wean of steroids was also instigated and the patient was managed on a surgical ward for 2\u2005weeks post-tonsillectomy.<\/jats:p>","DOI":"10.1136\/bcr-2014-207111","type":"journal-article","created":{"date-parts":[[2014,11,14]],"date-time":"2014-11-14T14:35:58Z","timestamp":1415975758000},"page":"bcr2014207111","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Blood, sweat and tears: androgenic-anabolic steroid misuse and recurrent primary post-tonsillectomy haemorrhage"],"prefix":"10.1136","volume":"2014","author":[{"given":"Richard","family":"Fox","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kiran","family":"Varadharajan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bhavesh","family":"Patel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Issa","family":"Beegun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2014,11,14]]},"reference":[{"key":"2025042706555824000_2014.nov14_1.bcr2014207111.1","doi-asserted-by":"crossref","unstructured":"Windfuhr JP , Verspohl BC , Chen YS , et al . Post-tonsillectomy hemorrhage-some facts will never change. Eur Arch Otorhinolaryngol 2014 Apr 16 (Epub ahead of print).","DOI":"10.1007\/s00405-014-3025-3"},{"key":"2025042706555824000_2014.nov14_1.bcr2014207111.2","unstructured":"National Prospective Tonsillectomy Audit Final Report 2005. 2005. Http:www.rcseng.ac.uk\/surgeons\/research\/surgicalresearch\/docs\/national%20prospective-%20tonsillectomy%20audit%20final%20report%202005.pdf\/view"},{"key":"2025042706555824000_2014.nov14_1.bcr2014207111.3","doi-asserted-by":"publisher","DOI":"10.3109\/10826084.2014.903751"},{"key":"2025042706555824000_2014.nov14_1.bcr2014207111.4","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1177\/014556130408300114","article-title":"Unidentified coagulation disorders in post-tonsillectomy hemorrhage","volume":"83","author":"Windfuhr","year":"2004","journal-title":"Ear Nose Throat J"},{"key":"2025042706555824000_2014.nov14_1.bcr2014207111.5","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215111000879"},{"key":"2025042706555824000_2014.nov14_1.bcr2014207111.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2273.2007.01381.x"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2014-207111","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T13:56:02Z","timestamp":1745762162000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2014-207111"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,11,14]]},"references-count":6,"alternative-id":["10.1136\/bcr-2014-207111"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2014-207111","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2014,11,14]]}}}