Pulmonary glue embolism : an unusual complication following endoscopic sclerotherapy for gastric varices

A pulmonary glue embolism is an unusual but potentially life-threatening complication following the treatment of variceal bleeding, especially in patients with large varices requiring large volumes of sclerosant. Other contributory factors include the rate of injection and ratio of the constituent c...

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Bibliographic Details
Published in:Sultan Qaboos University medical journal 2018-05, Vol.18 (2), p.231-235
Main Authors: Sidat, Shahid, Staicu, Anca, Antoniades, Georgios, Michael, Philips Jurj
Format: Article
Language:English
Subjects:
Adhesives - adverse effects
Aged
Antibiotics
Case Report
Case reports
Cyanoacrylates - adverse effects
Embolisms
Endoscopy
Esophageal and Gastric Varices - therapy
Gastrointestinal Hemorrhage - therapy
Humans
Hypertension
Liver cirrhosis
Lungs
Male
Medical imaging
Patients
Pneumonia
Pulmonary arteries
Pulmonary Embolism - diagnostic imaging
Pulmonary Embolism - etiology
Pulmonary embolisms
Respiratory distress syndrome
Retrospective Studies
Sclerotherapy - adverse effects
Sclerotherapy - methods
Tomography
Veins & arteries
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Summary:A pulmonary glue embolism is an unusual but potentially life-threatening complication following the treatment of variceal bleeding, especially in patients with large varices requiring large volumes of sclerosant. Other contributory factors include the rate of injection and ratio of the constituent components of the sclerosant (i.e. n-butylcyanoacrylate and lipiodol). This condition may be associated with a delayed onset of respiratory compromise. Therefore, a high degree of clinical suspicion is essential in patients with unexplained cardiorespiratory decline during or following endoscopic sclerotherapy. We report a 65-year-old man who was admitted to the Hull Royal Infirmary, Hull, UK, in 2017 with haematemesis and melaena. He subsequently developed acute respiratory distress syndrome secondary to a glue embolism following emergency sclerotherapy for bleeding gastric varices. The aetiology of the embolism was likely a combination of the large size of the gastric varices and the large volume of cyanoacrylate needed. After an endoscopy, the patient underwent transjugular intrahepatic portosystemic shunting twice to control the bleeding, after which he recovered satisfactorily.
ISSN:2075-051X
2075-0528
DOI:10.18295/squmj.2018.18.02.020