Abstract
Cirrhosis has many possible manifestations. These signs and symptoms may be either the direct results of liver cell failure or secondary to the resultant portal hypertension. Portal hypertension can decrease the number of platelets, which increases the risk of bleeding. Additionally, the liver plays a central role in hemostasis, because it is the site of clotting factors synthesis, coagulation inhibitors, and fibrinolytic proteins. Low platelet count and prolonged clotting times may increase the risk of epistaxis arising from minimal trauma, which can cause sometimes serious and occasionally fatal results. We experienced an intraoperative refractory epistaxis in a 60-year-old man with end-stage liver disease (ESLD) due to hepatitis B virus-related hepatocellular carcinoma during liver transplantation. The patient started severe epistaxis after we attempted to place a nasogastric (NG) tube. We describe successful management of massive epistaxis in an operating room under appropriate anesthesia and close hemodynamic monitoring. Keywords: End-stage liver disease; Epistaxis; Liver transplantation; Nasogastric tube
Highlights
Nasogastric tube induced refractory epistaxis during liver transplantationYun Hee Kim, Byung Gun Lim2*, Yong Sang Yoon, Soon Young Hong, Yoon Sook Lee, Woon Young Kim, Jung Hyun Don
Epistaxis from NG tube placement is rarely clinically severe in a normal population. It could be fatal in cases of abnormal coagulopathy
Camus M et al reported that most patients (80%) had epistaxis after a recently placed NG tube that might have initiated or exacerbated pharyngeal bleeding, especially in patients with end-stage liver disease (ESLD) [2]
Summary
Yun Hee Kim, Byung Gun Lim2*, Yong Sang Yoon, Soon Young Hong, Yoon Sook Lee, Woon Young Kim, Jung Hyun Don.
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