Swallowed nasal pack: a rare but serious complication of the management of epistaxis

Abstract

Packing of the nose with a suitable material remains a popular method of treating epistaxis. The authors report a serious complication of a new design of nasal pack; Rapid Rhino, which was swallowed during the treatment of a patient with epistaxis, resulting in bowel perforation.

Reply

“…In addition, insertion of an endotracheal tube may result in dislodgment of foreign bodies deeper into the airway, with very serious consequences, including total airway obstruction and death. As reported by Hashmi and colleagues [3], nasal packing material infrequently migrates into the supraglottic area and causes airway obstruction. What is more interesting is that this may occur regardless of the operator's skills (surgeon vs paramedic [1,2]).…”

Merocel Surgicel Wrap Technique to Manage Diffuse Epistaxis in Patients with Comorbidities

“…In addition, it is recommended to secure the string of Merocel to the nasal dorsum or cheek. However, Hashmi et al [24] reported a case of a nasal pack being swallowed during the treatment of epistaxis, which caused bowel obstruction and perforation.…”

Comparison of nasendoscopic-assisted cautery versus packing for the treatment of epistaxis

“…In addition, this may be exacerbated by aspiration of blood or by the use of sedative agents during insertion of the packs 1 . Swallowed nasal pack has also been reported as a rare but serious complication, resulting in perforation and peritonitis, requiring laparotomy 13 …”

“…Epistaxis occurs as a result of interaction of factors: damage to the nasal mucosal lining, disruption of vessel wall integrity, or alteration to the haemostatic system 1 . These include environmental (humidity, temperature), medications (nasal sprays, anticoagulant, anti‐platelet, non‐steroidal anti‐inflammatory medications), local (trauma, tumours, vascular and structural lesions) and systemic factors (vessel wall fibrosis in tunica media associated with ageing, hypertension, alcohol abuse, organ failure, coagulopathy) 1–3,6,8–13 . However, it is often (80–90%) that no precipitating cause can be identified 1,3 …”