Vascular embolization as an adjunct to surgical removal of percutaneously inserted foreign bodies in the pharynx to avoid the risk of massive bleeding: a case report

Rationale Percutaneous penetrating foreign bodies in the parapharyngeal space complicated by arterial injury are rare but pose a high risk of life-threatening hemorrhage, and optimal management strategies remain unclear. Patient concerns A 32-year-old man presented with a 4-day history of left infra-auricular swelling and a 1-day history of recurrent hematemesis after accidental penetration by a bamboo chopstick. Computed tomography showed a linear foreign body in the left parapharyngeal space, accompanied by surrounding tissue swelling and pharyngeal narrowing. Diagnosis The patient was diagnosed with a percutaneous penetrating foreign body in the left parapharyngeal–lateral skull base region, with suspected vascular injury. Interventions The patient underwent preoperative endovascular embolization of the left maxillary artery, followed by surgical removal of the foreign body and debridement under general anesthesia. Outcomes Angiography confirmed active bleeding from the maxillary artery. After embolization, the foreign body was successfully removed with minimal intraoperative blood loss (approximately 5 mL). The patient recovered without complications. Lessons In selected cases of penetrating parapharyngeal foreign bodies with arterial injury, preoperative embolization may reduce intraoperative bleeding risk and improve surgical safety.