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Profuse epistaxis following sphenoid surgery: a ruptured carotid artery pseudoaneurysm and its management

Published online by Cambridge University Press:  23 May 2008

D Biswas ,
A Daudia ,
N S Jones  and
N S McConachie
D Biswas*
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, University of Nottingham, UK
A Daudia
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, University of Nottingham, UK
N S Jones
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, University of Nottingham, UK
N S McConachie
Affiliation:
Department of Interventional Radiology, Queen's Medical Centre, University of Nottingham, UK
*
Address for correspondence: Mr D Biswas, Department of Otolaryngology and Head and Neck Surgery, Queens Medical Centre, University of Nottingham, Derby Road, Nottingham NG7 2UH, UK. Fax: +44 (0)1159709748 E-mail: drdbiswas@hotmail.com
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Abstract

Objective:

We report a rare case of iatrogenic pseudoaneurysm of the internal carotid artery secondary to endoscopic sphenoid surgery.

Method:

The management of this unusual complication and a review of the literature are presented.

Results:

A 65-year-old woman presented with intractable epistaxis four days following endoscopic sphenoid sinus surgery. Initial, conservative measures were unsuccessful in controlling bleeding. The clinical picture of delayed, severe epistaxis after a sphenoid sinus exploration raised the possibility of injury to the internal carotid artery and subsequent formation of a false aneurysm. The patient's pseudoaneurysm was managed, without visualising it, by packing the sphenoid sinus (achieved by palpating 1 cm above the shoulder of the posterior choana) in order to gain control of the haemorrhage, followed by endovascular occlusion.

Conclusion:

An awareness of this rare complication is essential in order to manage this life-threatening condition efficiently.

Keywords

Sphenoid SinusInternal Carotid ArteryEpistaxisPseudoaneurysm
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 6 , June 2009 , pp. 692 - 694
Copyright
Copyright © JLO (1984) Limited 2008

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Footnotes

Presented at the European Congress of Oto-Rhino-Laryngology (EUFOS), Head & Neck Surgery, July 2007, Vienna, Austria.

References

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