Oronasal bleeding that continues despite oronasal packs or recurs after removal of the oronasal packs is referred to as intractable oronasal bleeding, which is refractory to conventional treatments. Severe craniofacial injury or tumor in the nasal or paranasal cavity may cause intractable oronasal bleeding. These intractable cases are subsequently treated with surgical ligation or endovascular embolization of the bleeding arteries. While endovascular embolization has several merits compared to surgical ligation, the procedure needs attention because severe complications such as visual disturbance or cerebral infarction can occur. Therefore, comprehensive understanding of the head and neck vascular anatomy is essential for a more effective and safer endovascular treatment of intractable oronasal bleeding.
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Bullous pemphiogid (BP) is a chronic vesicular disorder and an autoimmune disease which has an autoantibodies to hemidesmosime in the keratinocyte. The authors report a case of gastrointestinal bleeding caused by BP involved with esophagus. A seventy year old man visited our clinic due to melena for a week. He had a quadriplegia due to fracture of cervical spine and was on therapy with corticosteroid and immunomodulatory drug for the diagnosis of BP. On endoscopic examination, multiple bullae filled with blood at lower esophagus was revealed and there was no other bleeding focus in stomach and duodenum. Medical treatment for BP with supportive care was done. The patient died due to sepsis caused by pneumonia. BP is common in elderly or poor conditioned patients. We need to consider the invasion of esophagus in case of gastrointestinal bleeding in patients with BP.
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