Severe Hemorrhage Requiring Transfusion in Two Dogs Following Right Inferior Alveolar Artery Laceration Secondary to...

To describe the presentation, management, and outcome of two dogs with severe hemorrhage after laceration of the inferior alveolar artery (IAA) caused by advanced periodontitis.

A 9-year-old neutered female Jack Russell Terrier (Case 1) and a 12-year-old intact female Bearded Collie (Case 2) were referred for further investigation of stomatorrhagia, melena, and hematemesis. Both cases were anemic (PCV 21% and 20%, respectively) on presentation, with Case 1 exhibiting signs of hemorrhagic shock. Profuse hemorrhage from the right mandibular quadrant originating at the first molar and severe periodontitis were identified on oral examination. Platelet count, activated partial thromboplastin time (aPTT), and prothrombin time (PT) were normal in both cases. Hyperfibrinolysis was identified in Case 1 on viscoelastic testing. Initial management included fluid resuscitation, tranexamic acid, and packed RBC transfusions (28 and 14 mL/kg for Cases 1 and 2, respectively). Both cases required anesthesia and surgical arteriolar ligation for hemostatic control. In both dogs, a laceration of the right IAA was identified, and dental extractions and ligation of the IAA were performed. Intraoperative dental radiographs confirmed periodontitis as the underlying cause for hemorrhage in Case 1; in Case 2, a preoperative computed tomography scan of the head was used. Surgery was curative for the oral hemorrhage in both cases; however, Case 1 died secondary to comorbidities.

This is the first published report of severe anemia and hemorrhagic shock secondary to IAA hemorrhage due to advanced periodontitis in any species. This case series demonstrates that IAA erosion needs to be considered as a differential diagnosis for severe oral hemorrhage and should be recognized as a condition that may require emergency surgery in veterinary medicine.