Clinical Case Summary

A 38 year old female with jaundice, multiple limb bruises and a left breast haematoma on a background of decompensated alcohol related cirrhosis, presented to our hospital’s emergency department in December 2024 with spontaneous oropharyngeal bleeding. There was no history of any oropharyngeal infections, trauma, tongue bite or alcohol withdrawal seizure. She lost a litre of blood in a four-five hour period following her presentation in the emergency department. Initial interventions by ENT surgery team and Maxillofacial surgery teams proved unsuccessful in achieving definitive haemostasis in the glossal bed. This resulted in airway compromise which was managed by intubation by the anaesthetics team. Following input from the interventional radiology team, patient underwent angiograms of the right and left external carotid and common carotid arteries and a vascular blush was identified. She underwent successful embolization of the right sided facio-lingual and left sided lingual vessels and haemostasis was achieved.
Patient remained intubated in ITU and received management for ongoing coagulopathy and hepatic encephalopathy. Following step down to the Gastroenterology ward, extensive dietitian, physiotherapy, speech and language therapy input was required. She achieved baseline status after one month of extensive medical management and her cognitive function improved. She was eventually discharged to a rehabilitation assessment bed.
Spontaneous lingual artery haemorrhage is a rare manifestation of coagulopathy secondary to cirrhosis with other cases in literature stemming mainly from a co-existing asymptomatic pseudoaneurysm. This case illustrates an atypical presentation of decompensated liver cirrhosis with an acute spontaneous lingual artery haemorrhage requiring embolization of bilateral facio-lingual vessels. It emphasizes the need for early joined up multidisciplinary care and intervention to achieve haemostasis and a successful outcome in these patients.

Disclosure

The authors declare no conflict of interest