Cyanoacrylate glue in the management of blue rubber bleb nevus syndrome.

ber bleb nevus syndrome (BRBNS) was admitted for occult bleeding. He had a history of gastric and colonic hemangiomas treated 2 years earlier by argon plasma coagulation and alcohol injection respectively. Clinical examination showed a few hemangiomas on his back and feet (●" Fig. 1). Capsule endoscopy (Pillcam SB2; Given Imaging, Yoqneam, Israel) disclosed three blebs of the small bowel (●" Fig. 2), and the patient underwent double-balloon enteroscopy (Fujinon, Saitama, Japan). A 2-cm bleb was found at the jejunum, two smaller lesions at the ileum, and one at the transverse colon. N-butyl-2cyanoacrylate and methacryloxysulfolane (Glubran 2), 1ml, diluted with Lipiodol, 1ml, was injected in aliquots of 1ml per injection and up to 4ml at each lesion (●" Fig. 3). No complications occurred. At 6-month follow-up the patient had no anemia. Case 2. An 11-year-old girl with BRBNS was addressed for hematochezia due to colonic blebs. Colonoscopy revealed a bleeding lesion at the cecum (●" Fig. 4). After initial failure to stop the bleeding with a hemostatic grasper (Coagrasper, Olympus), Glubran 2 was injected successfully. Two more blebs of the right colon were treated similarly. After 2 years the patient remained asymptomatic. Cyanoacrylate glue in the management of blue rubber bleb nevus syndrome