A 12-year-old girl presented for excision of a nevus sebaceous of the scalp. The surgery was complicated by unexpected difficult-to-control bleeding in the operating room. Numerous attempts to obtain hemostasis were unsuccessful including the use of local anesthetic containing epinephrine, direct pressure, wall suction, monopolar electrocautery using different tip sizes, sponge sticks, and Gelfoam. Finally bleeding was contained using a suction-electocautery unit frequently used by otolaryngology. This article reviews the usual causes of unexpected bleeding in the pediatric population and both familiar and unfamiliar methods to control operative bleeding.