Endoscopic cauterization and excision of a bleeding vallecular varix using Endopath bipolar macro forceps
Introduction: Vallecular varices are easy to overlook because of their small size and intermittent bleeding pattern, but they can cause dramatic blood loss. Here we describe our novel method of treating a bleeding vallecular varix using the Ethicon Endopath 5mm bipolar forceps with macro jaw (Endopa...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-03-01
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| Series: | Otolaryngology Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468548821000060 |
| _version_ | 1818850102146498560 |
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| author | Mariah M. Servos Prashanthi Divakar Benoit J. Gosselin |
| author_facet | Mariah M. Servos Prashanthi Divakar Benoit J. Gosselin |
| author_sort | Mariah M. Servos |
| collection | DOAJ |
| description | Introduction: Vallecular varices are easy to overlook because of their small size and intermittent bleeding pattern, but they can cause dramatic blood loss. Here we describe our novel method of treating a bleeding vallecular varix using the Ethicon Endopath 5mm bipolar forceps with macro jaw (Endopath), a tool originally designed for use during laparoscopic surgery. Case description: A healthy 59-year-old female presented to the emergency department with a week of hemoptysis, postnasal drip, and occasional epistaxis. Labs were notable for hemoglobin 7.5g/dL. Nasopharyngolaryngoscopy revealed a pedunculated, vascular-appearing lesion in the left vallecula that bled sluggishly during a Valsalva maneuver. The patient underwent direct laryngoscopy and operative excision. The stalk was cauterized using Endopath and the varix was separated from the surrounding vallecular tissues with a combination of Endopath bipolar forceps and sharp dissection using microlaryngoscopy scissors. Results: The patient had no further bleeding episodes and was discharged on post-operative day one. Final pathology confirmed the vallecular lesion was a varix. Seven weeks post-operatively, her hemoglobin was stable at 14.8 g/dL. Conclusion: A vallecular varix should be considered in patients with significant bleeding from the oral cavity when history is not suggestive of pulmonary, gastrointestinal, or nasal source. Thermal cauterization with the Endopath and excision with microlaryngoscopy scissors is a successful treatment for a bleeding vallecular varix. The Endopath bipolar forceps are a useful new addition to the otolaryngologist's armamentarium. |
| first_indexed | 2024-12-19T06:43:47Z |
| format | Article |
| id | doaj.art-e16805e4a5834a9fba2cba3aeeceaa17 |
| institution | Directory Open Access Journal |
| issn | 2468-5488 |
| language | English |
| last_indexed | 2024-12-19T06:43:47Z |
| publishDate | 2021-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Otolaryngology Case Reports |
| spelling | doaj.art-e16805e4a5834a9fba2cba3aeeceaa172022-12-21T20:31:58ZengElsevierOtolaryngology Case Reports2468-54882021-03-0118100266Endoscopic cauterization and excision of a bleeding vallecular varix using Endopath bipolar macro forcepsMariah M. Servos0Prashanthi Divakar1Benoit J. Gosselin2Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Road, Hanover, NH, 03NH755, United StatesDartmouth-Hitchcock Medical Center, Department of Surgery, Section of Otolaryngology, One Medical Center Drive, Lebanon, NH, 03756, United States; Corresponding author.Dartmouth-Hitchcock Medical Center, Department of Surgery, Section of Otolaryngology, One Medical Center Drive, Lebanon, NH, 03756, United StatesIntroduction: Vallecular varices are easy to overlook because of their small size and intermittent bleeding pattern, but they can cause dramatic blood loss. Here we describe our novel method of treating a bleeding vallecular varix using the Ethicon Endopath 5mm bipolar forceps with macro jaw (Endopath), a tool originally designed for use during laparoscopic surgery. Case description: A healthy 59-year-old female presented to the emergency department with a week of hemoptysis, postnasal drip, and occasional epistaxis. Labs were notable for hemoglobin 7.5g/dL. Nasopharyngolaryngoscopy revealed a pedunculated, vascular-appearing lesion in the left vallecula that bled sluggishly during a Valsalva maneuver. The patient underwent direct laryngoscopy and operative excision. The stalk was cauterized using Endopath and the varix was separated from the surrounding vallecular tissues with a combination of Endopath bipolar forceps and sharp dissection using microlaryngoscopy scissors. Results: The patient had no further bleeding episodes and was discharged on post-operative day one. Final pathology confirmed the vallecular lesion was a varix. Seven weeks post-operatively, her hemoglobin was stable at 14.8 g/dL. Conclusion: A vallecular varix should be considered in patients with significant bleeding from the oral cavity when history is not suggestive of pulmonary, gastrointestinal, or nasal source. Thermal cauterization with the Endopath and excision with microlaryngoscopy scissors is a successful treatment for a bleeding vallecular varix. The Endopath bipolar forceps are a useful new addition to the otolaryngologist's armamentarium.http://www.sciencedirect.com/science/article/pii/S2468548821000060Endopath bipolarVallecular varixOropharyngeal hemorrhage |
| spellingShingle | Mariah M. Servos Prashanthi Divakar Benoit J. Gosselin Endoscopic cauterization and excision of a bleeding vallecular varix using Endopath bipolar macro forceps Otolaryngology Case Reports Endopath bipolar Vallecular varix Oropharyngeal hemorrhage |
| title | Endoscopic cauterization and excision of a bleeding vallecular varix using Endopath bipolar macro forceps |
| title_full | Endoscopic cauterization and excision of a bleeding vallecular varix using Endopath bipolar macro forceps |
| title_fullStr | Endoscopic cauterization and excision of a bleeding vallecular varix using Endopath bipolar macro forceps |
| title_full_unstemmed | Endoscopic cauterization and excision of a bleeding vallecular varix using Endopath bipolar macro forceps |
| title_short | Endoscopic cauterization and excision of a bleeding vallecular varix using Endopath bipolar macro forceps |
| title_sort | endoscopic cauterization and excision of a bleeding vallecular varix using endopath bipolar macro forceps |
| topic | Endopath bipolar Vallecular varix Oropharyngeal hemorrhage |
| url | http://www.sciencedirect.com/science/article/pii/S2468548821000060 |
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