Unusual cause of recalcitrant epistaxis

Area of Science:

• Otorhinolaryngology
• Vascular Surgery
• Emergency Medicine

Background:

• Nosebleeds are common emergency department presentations.
• Bleeding from anterior ethmoid artery (AEA) septal branches is typically manageable endoscopically.
• Pseudoaneurysms of the AEA septal branches are exceptionally rare and difficult to control.

Observation:

• An adult patient experienced severe, persistent epistaxis following a road traffic accident.
• Digital subtraction angiography confirmed a pseudoaneurysm of a nasal septal branch of the AEA.
• Profuse bleeding prevented endoscopic visualization and control.

Findings:

• The patient required repeated nasal packing due to intractable hemorrhage.
• An external surgical approach was necessary to ligate the AEA and achieve hemostasis.
• This case underscores the diagnostic and therapeutic challenges posed by AEA pseudoaneurysms.

Implications:

• This report expands the understanding of rare causes of severe epistaxis.
• It emphasizes the limitations of endoscopic techniques for certain complex vascular injuries.
• The findings suggest that external ligation of the AEA may be a viable option for life-threatening nasal hemorrhage from pseudoaneurysms.