Carotid Blow-out syndrome: Challenges in management of epistaxis in a post-surgical intervention and radiated patient
Recurrent epistaxis is a red flag in post-nasal surgery and previously radiated cancer patients. The incidence of carotid blow-out syndrome is seven times higher in previously radiated patients. Today, nasal endoscopy has become an essential tool in our practice. It helps in identifying the source...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Malaysian Medical Association
2021
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| Subjects: | |
| Online Access: | http://ir.unimas.my/id/eprint/37445/1/epistaxis.pdf http://ir.unimas.my/id/eprint/37445/ http://www.e-mjm.org/2021/v76s1/index.html |
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| Institution: | Universiti Malaysia Sarawak |
| Language: | English |
| Summary: | Recurrent epistaxis is a red flag in post-nasal surgery and previously radiated cancer patients. The incidence of carotid blow-out
syndrome is seven times higher in previously radiated patients. Today, nasal endoscopy has become an essential tool in our
practice. It helps in identifying the source of bleeding and facilitates therapeutic management. On the other hand, radio imaging
is highly sensitive and specific to detect vascular lesions. However, they are not perfect. This paper presents a treated sphenoid sinus
carcinoma patient with the right internal carotid thrombosis who presented with sentinel epistaxis. Endoscopic nasal examination
and radio imaging failed to identify the bleeder and misled to a wrong source of bleeding. The bleeder was finally detected via the
examination under anaesthesia (EUA). The carotid blowout occurred intraoperatively. Management of this patient is extra
challenging as the blow-out vessel was the only major blood supply to the anterior cerebral circulation. The haemostasis was
secured with a muscular patch and a vascular stent inserted. He was free from the neurological deficit. Unfortunately, profuse
epistaxis recurred on post-operative day five. Although nasal packing controlled his recurrent epistaxis, he developed anterior
circulation infarct later on and succumbed to death. The authors wish to highlight the importance of EUA if radio imaging does
not correlate to the clinical findings. Management options for carotid blow-out should tailor to the patients’ medical conditions. |
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