Epistaksis masif pada pseudoaneurisma traumatik arteri karotis interna

Abstract

Latar belakang: Pseudoaneurisma arteri karotis interna merupakan kasus yang jarang dijumpai, dengan gejala berupa perdarahan masif yang dapat terjadi secara lambat dan berulang. Pemeriksaan arteriografi merupakan prosedur standar untuk mengetahui sumber perdarahan. Tindakan embolisasi efektif untuk menghentikan perdarahan. Tujuan: Melaporkan kasus epistaksis masif pada pseudoaneurisma traumatik arteri karotis interna. Kasus: Pasien laki-laki berumur 19 tahun dengan trauma sinus sfenoid pasca kecelakaan, mengalami epistaksis masif berulang selama 7 bulan. Hasil nasoendoskopi didapati bekuan darah pada meatus superior, hasil CT scan menunjukkan lesi isodens pada sinus frontalis dan etmoid kanan, serta sinus sfenoid dan maksila bilateral, disertai gambaran arteri karotis komunis interna segmen kavernosus masuk ke sinus sfenoid melalui celah fraktur di sfenoid. Penatalaksaan berupa embolisasi dengan balloon. Pasca embolisasi tidak didapatkan perdarahan aktif. Metode: Penelusuran kepustakaan menghasilkan 33 jurnal, dan terdapat 10 jurnal yang relevan. Hasil: Dari 10 jurnal yang didapatkan, ditemukan 6 laporan kasus dan 4 hasil penelitian pseudoaneurisma traumatik arteri karotis interna yang ditatalaksana dengan embolisasi, mendapat keberhasilan yang tinggi, dan angka komplikasi yang rendah. Kesimpulan: Pseudoaneurisma traumatik karotis interna menimbulkan epistaksis masif berulang, yang membutuhkan ketepatan pemeriksaan penunjang untuk menegakkan diagnosis. Penatalaksanaan dengan embolisasi merupakan pilihan yang efektif untuk mencegah mortalitas.

Kata kunci: Pseudoaneurisma karotis interna, trauma sinus sfenoid, epistaksis masif

ABSTRACT

Background: Post injury internal carotid artery pseudoaneurysm is a rare case, mostly caused by head trauma. The symptoms are delayed and recurrent massive epistaxis. Angiography is the gold standard for confirming the diagnosis and visualizing the bleeding point. Endovascular interventions with depleted balloons and coils are effective treatment. Purpose: To report a case of massive epistaxis related to traumatic pseudoaneurysm of internal carotid artery. Case: A nineteen-years old male with sphenoid sinus injury caused by vehicle accident, which subsequently developed recurrent episodes of massive epistaxis for seventh month afterwards. He had undergone blood transfusion and nasal packing to control the bleeding. Nasal endoscopic examination showed blood clot in the superior meatus, while paranasal sinuses CT Scan showed isodense lesion in the right frontal and ethmoid sinuses, and bilateral sphenoid and maxillary sinuses. Cavernous segment of carotid communis artery entered into sphenoid sinus through a fracture line in the superior part of the sinus. Post arteriography and balloon embolization, there was no active anterior and posterior bleeding. Method: Searching for evidence produced 31 journals, and 10 journals were relevant to our clinical question. Result: From the 10 journals, 6 were case reports and 4 were researches of traumatic pseudoaneurysm of internal carotid artery which were treated by embolization. The results were good and complications were minimal. Conclusion: Traumatic pseudoaneurysm of internal carotid artery could cause massive epistaxis that requires a right clinical setting to diagnose, and embolization is the effective treatment to prevent mortality.

Keywords: Internal carotid artery pseudoaneurysm, sphenoid sinuses trauma, massive epistaxis