Acute pulmonary embolism following N-butyl-cyanoacrylate endoscopic injection sclerotherapy
نویسندگان
چکیده
Endoscopic injection of N-butyl-2-cyanoacrylate (Histoacryl) is widely used for the control of gastric variceal bleeding with initial hemostasis rates of 87-100% [1,2]. However, Histoacryl injection has been associated with major complications, including embolism, sepsis, fistula and adherence of the needle within the varix [3,4]. We report a 32-year-old male patient with chronic hepatitis B infection, who presented to our emergency department with loss of consciousness following hematemesis and melena. Due to torrential bleeding, the patient was incubated and underwent upper gastrointestinal endoscopy in the operating theater. An acutely bleeding isolated fundic varix was found, which was obliterated with 2 cc of a 1:1 mixture of Histoacryl (B. Braun, Germany) with Lipiodol (Guerbert, France). Despite successful hemostasis, the patient immediately exhibited ventricular tachycardia, hypoxia (O2 saturation of 89%), and hypotension (systolic blood pressure of 70 mmHg). The arrhythmia was treated with i.v. infusion of amiodaron (Angoron, SanofiAventis, France) and circulation instability was reversed. A chest radiograph revealed multiple bilateral pulmonary emboli of the Histoacryl/lipiodol mixture (Fig. 1). Pulmonary embolism was confirmed by computed tomography (CT), which showed no evidence of lung infarcts (Fig. 2). The patient remained hemodynamically stable, and hypoxia was reversed within 48 h. Our patient illustrates the risk of pulmonary embolization following sclerotherapy with even small volumes of Histoacryl/lipiodol. Despite eventual recovery of normal lung function, pulmonary embolism with Histoacryl/lipiodol can cause life threatening cardiovascular complications such as ventricular tachycardia that require appropriate monitoring and treatment settings for their management.
منابع مشابه
N-butyl-2-cyanoacrylate and lipoidol pulmonary embolism (glue embolism).
Glue embolisation is a rare happening and many clinicians who evaluate patients for post sclerotherapy problems may be unaware of this complication. We present a case of pulmonary embolism in a patient of cirrhosis liver secondary to gastric variceal sclerotherapy with N-Butyl-2-cyanoacrylate and lipoidol solution. This is also called glue embolism.
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Pulmonary embolism following 2-octyl-cyanoacrylate/lipiodol injection for obliteration of gastric varices: an imaging perspective.
Bleeding from esophageal and gastric varices remains a significant cause of morbidity and mortality for patients with liver cirrhosis. Currently, therapeutic strategies for gastric variceal bleeding include transjugular intrahepatic portosystemic shunt, cyanoacrylate sclerotherapy and hepatic transplantation. Though relatively safe and efficacious, endoscopic sclerotherapy using cyanoacrylate h...
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Bleeding gastric varices are increasingly being obliterated with the aid of endoscopic injection of n-butyl-cyanoacrylate (histoacryl) diluted with lipiodol. This glue acts as a tissue adhesive that polymerizes on contact with blood in a gastric varix. Severe glue pulmonary embolism is a rare complication of injection therapy. This case involves a 52-year-old man with fundal gastric varices, wh...
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Background: To evaluate the hemostatic effects of emergent Eendoscopic Variceal Sclerotherapy (EIS) combined with acrylate glue (N-butyl-2-cyanoacrylate, NBCA) injection (ESCI) on esophageal variceal bleeding, and to investigate glue extrusion after endoscopic injection. Methods: The rate of hemostasis and blood transfusion in patients that received ESCI were compared to 16 patients who receive...
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