Severe epistaxis in pregnancy due to nasal pyogenic granuloma: A case report

Abstract

Mild to severe epistaxis is common in pregnancy and often results from increased vascularity of the nasal mucosa and hormonal changes. Symptoms may occur in the absence of an obvious local cause or any systemic disorder; however, thorough otolaryngological (i.e., “ENT”) evaluation is always warranted. Pyogenic granuloma or lobular capillary haemangioma is a benign fibrovascular proliferative tumour that is commonly found on the face, fingers, lips, and nasal mucosa. Pregnancy-induced pyogenic granuloma is not an uncommon entity and may result in torrential epistaxis if untreated. Managing a case of severe epistaxis during pregnancy usually requires multidisciplinary management. The authors present a case of severe epistaxis in pregnancy that necessitated examination of the nasal cavity under general anaesthesia. Intraoperative findings showed a bluish-red mass occupying the patient's right maxillary sinus. Bleeding was arrested and complete haemostasis was achieved. The nasal pyogenic granuloma completely resolved in the post-partum period.

Management of Capillary Hemangioma of the Sphenoid Sinus

“…The treatment should be efficient but as conservative as possible and care should be taken when prescribing certain drugs. Mohd Yusof J. et al consider chemical cauterization with silver nitrate and anterior nasal packing to be first-line treatment for mild epistaxis during pregnancy [ 15 ]. In case of severe nose hemorrhage, surgical intervention with general anesthesia is necessary to control the epistaxis; all measures should be taken to minimize the risks of general anesthesia to the fetus [ 15 ].…”

“…Mohd Yusof J. et al consider chemical cauterization with silver nitrate and anterior nasal packing to be first-line treatment for mild epistaxis during pregnancy [ 15 ]. In case of severe nose hemorrhage, surgical intervention with general anesthesia is necessary to control the epistaxis; all measures should be taken to minimize the risks of general anesthesia to the fetus [ 15 ]. Another classification of hemangiomas takes into account the presence or absence of a protein named endothelial cell glucose transporter 1 (GLUT1) [ 16 ].…”