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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: [email protected]
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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

1 Hollis, LJ, McGlashan, JA, Walsh, RM, Bowdler, DA. Massive epistaxis following sphenoid sinus exploration. J Laryngol Otol 1994;108:171–3CrossRefGoogle ScholarPubMed
2 Reddy, K, Lesiuk, H, West, M, Fewer, D. False aneurysm of the cavernous carotid artery: a complication of transsphenoidal surgery. Surg Neurol 1990;33:142–5CrossRefGoogle ScholarPubMed
3 Lister, JR, Sypert, GW. Traumatic false aneurysm and carotid-cavernous fistula: a complication of sphenoidotomy. Neurosurgery 1979;5:473–5CrossRefGoogle ScholarPubMed
4 Tampieri, D, Atkinson, JD, Daniel, SJ, Teitelbaum, J, Shemie, SD. Posttraumatic pseudoaneurysm of the intracavernous internal carotid artery presenting with massive epistaxis. Pediatr Crit Care Med 2006;7:260–2Google Scholar
5 Bavinzski, G, Killer, M, Knosp, E, Ferraz-Leite, H, Gruber, A, Richling, B. False aneurysms of the intracavernous carotid artery – report of 7 cases. Acta Neurochir (Wien) 1997;139:37–43CrossRefGoogle ScholarPubMed
6 Celil, G, Engin, D, Orhan, G, Barbaros, C, Hakan, K, Adil, E. Intractable epistaxis related to cavernous carotid artery pseudoaneurysm: treatment of a case with covered stent. Auris Nasus Larynx 2004;31:275–8CrossRefGoogle ScholarPubMed
7 Cockroft, KM, Carew, JF, Trost, D, Fraser, RA. Delayed epistaxis resulting from external carotid artery injury requiring embolization: a rare complication of transsphenoidal surgery: case report. Neurosurgery 2000;47:236–9Google ScholarPubMed
8 Kai, Y, Hamada, J, Nishi, T, Ushio, Y. Successful treatment with bypass and interventional surgery for a ruptured pseudo carotid artery aneurysm after transsphenoidal surgery: a case report [in Japanese]. No Shinkei Geka 2001;29:241–5Google ScholarPubMed
9 Vergez, S, Folia, M, Michenet, F, Rose, X, Lacroix-Loubes, F, Percodani, J et al. Pseudoaneurysm of the internal carotid artery revelated by epistaxis: report of two cases [in French]. Rev Laryngol Otol Rhinol (Bord) 2005;126:151–4Google ScholarPubMed