BMJ Case Reports 2013; doi:10.1136/bcr-2012-007278
  • Unexpected outcome (positive or negative) including adverse drug reactions

Severe epistaxis after nasogastric tube insertion requiring arterial embolisation

  1. Sidney Tessler
  1. Department of Medicine, Division of Pulmonary & Critical Care Medicine, Maimonides Medical Center, Brooklyn, New York, USA
  1. Correspondence to Dr Sidney Tessler, stessler{at}


A 53-year-old dialysis patient was admitted with symptoms of a respiratory tract infection, abdominal pain and vomiting. She aspirated and required intubation. A nasogastric tube was placed with slight difficulty and the patient developed severe epistaxis. The bleeding could not be controlled with mechanical pressure and nasal packing. Angiography revealed extravasation from a pseudoaneurysm arising from the inferior pharyngeal branch of the ascending pharyngeal trunk. The vessel was successfully embolised with cessation of bleeding. We emphasise that even a seemingly easy procedure like insertion of a nasogastric tube, can lead to a life-threatening complication.

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