Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-28T06:26:16.181Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

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