Clinical Report: Posterior nasal bleeding resembling intra-abdominal hemorrhage

Overview

This report details a unique case of posterior nasal bleeding following gastrectomy, which was initially misdiagnosed as intra-abdominal hemorrhage due to the presentation of bright red blood from the abdominal drain. The case highlights the importance of considering atypical sources of bleeding when conventional diagnostic methods fail.

Background

Postoperative hemorrhage is a significant complication after gastrectomy, with incidence rates ranging from 1% to 4% and associated mortality rates as high as 20%. Accurate diagnosis is crucial, especially when conventional imaging and endoscopy do not reveal the source of bleeding. This case emphasizes the need for vigilance in identifying remote bleeding sites in postoperative patients.

Data Highlights

No numerical data or trial data were presented in the article.

Key Findings

• A 77-year-old woman developed a posterior nasal cavity bleed after total gastrectomy.
• Initial assessments, including CT and endoscopy, failed to identify the source of bleeding.
• The abdominal drain had migrated into the jejunal lumen through an anastomotic leak.
• Nasendoscopy ultimately revealed the posterior nasal cavity as the source of bleeding.
• Endoscopic electrocautery was successfully used to achieve hemostasis.

Clinical Implications

Clinicians should maintain a high index of suspicion for atypical bleeding sources in postoperative patients, especially when standard diagnostic tools do not yield results. Investigating remote bleeding sites can be critical in managing postoperative hemorrhage effectively.

Conclusion

This case underscores the importance of thorough investigation in cases of postoperative hemorrhage where conventional methods fail to localize the source. Awareness of atypical drainage pathways can aid in accurate diagnosis and treatment.

Related Resources & Content

1. Journal of Gastrointestinal Surgery, 2015 -- Evaluation and Management of Postoperative Abdominal Arterial Hemorrhage Following Radical Gastrectomy: Insights from a Retrospective Study of 1875 Gastric Cancer Resections
2. Frontiers in Medicine, 2026 -- Occult fish bone ingestion inducing cross-site injury: a rare case report of gastric bleeding and jejunal perforation
3. Frontiers in Oncology, 2026 -- Rare Case report and Literature Review of Peripheral T-Cell Lymphoma Presenting as Massive Gastrointestinal Hemorrhage: An Unusual Etiology Demanding Emergency Surgical Intervention
4. Houston Methodist Hospital -- Upper GI Bleeding After Esophago-Gastrectomy
5. Clinical features of postoperative anastomotic bleeding after gastrectomy and efficacy of endoscopic hemostasis: a case-control study - PubMed
6. Red Blood Cell Transfusion: 2023 AABB International Guidelines - PubMed
7. Frontiers | Posterior nasal hemorrhage mimicking intra-abdominal hemorrhage after gastrectomy: a case report
8. Clinical features of postoperative anastomotic bleeding after gastrectomy and efficacy of endoscopic hemostasis: a case-control study - PubMed
9. Red Blood Cell Transfusion: 2023 AABB International Guidelines - PubMed
10. Frontiers | Posterior nasal hemorrhage mimicking intra-abdominal hemorrhage after gastrectomy: a case report