Endoscopic cauterization and excision of a bleeding vallecular varix using Endopath bipolar macro forceps

Abstract

Introduction: Vallecular varices are easy to overlook because of their small size and intermittent bleeding pattern, but they can cause dramatic blood loss. Here we describe our novel method of treating a bleeding vallecular varix using the Ethicon Endopath 5mm bipolar forceps with macro jaw (Endopath), a tool originally designed for use during laparoscopic surgery. Case description: A healthy 59-year-old female presented to the emergency department with a week of hemoptysis, postnasal drip, and occasional epistaxis. Labs were notable for hemoglobin 7.5g/dL. Nasopharyngolaryngoscopy revealed a pedunculated, vascular-appearing lesion in the left vallecula that bled sluggishly during a Valsalva maneuver. The patient underwent direct laryngoscopy and operative excision. The stalk was cauterized using Endopath and the varix was separated from the surrounding vallecular tissues with a combination of Endopath bipolar forceps and sharp dissection using microlaryngoscopy scissors. Results: The patient had no further bleeding episodes and was discharged on post-operative day one. Final pathology confirmed the vallecular lesion was a varix. Seven weeks post-operatively, her hemoglobin was stable at 14.8 g/dL. Conclusion: A vallecular varix should be considered in patients with significant bleeding from the oral cavity when history is not suggestive of pulmonary, gastrointestinal, or nasal source. Thermal cauterization with the Endopath and excision with microlaryngoscopy scissors is a successful treatment for a bleeding vallecular varix. The Endopath bipolar forceps are a useful new addition to the otolaryngologist's armamentarium.

Keywords

• Endopath bipolar
• Vallecular varix
• Oropharyngeal hemorrhage