A 57-year-old black female was seen at the Medical Center. At that time, she had been treated for epistaxis at an outlying hospital and referred for continued care.

She had undergone multiple nasal cauterizations, nasal pack placements, and blood transfusions.
On examination Gelfoam was found in her nasal cavity bilaterally, and a plastic clamp was in place on the nasal alae.
The Gelfoam was removed and a significant amount of clot was suctioned from the nose and nasopharynx.
Multiple excoriated areas of nasal mucosa were seen and there was some active bleeding on the left side of the nose.
A formal anterior/posterior nasal pack was placed for four days.
Her blood pressure control was adequate at all times and his hemoglobin and hematocrit remained stable.
Her prothrombin time and partial thromboplastin time were normal.
After pack removal, the patient was observed for 24 hours and discharged without incident. 

Two weeks later, she returned with recurrent left-sided nasal bleeding which appeared to be originating from the area of the nasal roof anteriorly.
Her hematocrit was 30.8 and a bleeding time was obtained and found to be normal.
She was taken to the operating room at which time his left anterior ethmoid artery was ligated.
Remained dry for approximately 24 hours after surgery but again rebled from the left side of the nose.
She was then returned to the operating room for left posterior ethmoid and transantral maxillary artery ligation.
During the postoperative period, two units of red blood cells were transfused.
Following these procedures, her nasal pack was removed five days after surgery and he eventually did well. 

Subsequent long-term follow-up documented the presence of a small septal perforation which had been identified during his active bleeding episodes.
This was closed surgically seven months after his arterial ligations.
She continues to experience intermittent nasal crusting with occasional mild bilateral bleeding, but is otherwise doing well.