Surgical treatment of nasal packing refractory epistaxis.
Epistaxis is the main otorhinolaryngology emergency and, in severe cases, it can lead to hemodynamic instability and be life threatening.


OBJECTIVE
To evaluate factors involved in epistaxis resistant to nasal packing that needed surgical treatment, as well as post-surgical results.


METHODS
Retrospective study from January 2002 to August 2007. 40 consecutive patients that underwent surgical treatment for refractory epistaxis were analyzed. Predisposing factors, procedures performed, need of blood transfusion, and recurrence were evaluated.


RESULTS
Otorhinolaryngology post operative complications (37.5%), high blood pressure (30%), and coagulopathy (15%) were the main factors related to epistaxis. 50% of the patients (n=20) presented with hemodynamic instability and 90% of them (n=18) needed blood transfusion. Eletrocauterization of the bleeding site was enough in 35% of these patients (n=14), while in 65% (n=26) was necessary cauterization and/or arterial ligation. Five patients (12.5%) had bleeding recurrence, which needed re-operation.


CONCLUSIONS
Earlier indications of surgical treatment to control severe and refractory epistaxis to conventional treatment, especially in a population with high risk such as post operative bleeding and coagulopathies, may decrease the need of blood transfusion.
Rabelo
Fábio Augusto Winckler
FA
Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo.
Prado
Vírgilio Batista do
VB
Valera
Fabiana Cardoso Pereira
FC
Demarco
Ricardo Cassiano
RC
Tamashiro
Edwin
E
Lima
Wilma Terezinha Anselmo
WT
D000293:Adolescent; D000328:Adult; D000368:Aged; D002425:Cautery; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004844:Epistaxis / Q000601:surgery*; D005260:Female; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult