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.