Life-threatening intraabdominal arterial embolization after histoacryl injection for bleeding gastric ulcer

Endoscopy. 2000 May;32(5):422-4. doi: 10.1055/s-2000-9002.

Abstract

N-butyl-cyanoacrylate (Histoacryl) injection has become the treatment of choice for acutely bleeding esophagogastric varices, and is the only effective option for endoscopic treatment of gastric varices. Recent reports confirm the ability of Histoacryl injection therapy to achieve immediate hemostasis in cases of gastric ulcer bleeding or Dieulafoy ulcer, where conventional endoscopic hemostatic treatment had failed. Although the overall safety record of Histoacryl injection has been relatively good, there have been scattered cases of serious complications. Here, we present two patients showing life-threatening intraabdominal arterial embolization after Histoacryl injection. They had chronic gastric ulcers with active arterial bleeding. In spite of attempts at hemostatic treatment, complete hemostasis was not achieved. We injected Histoacryl, diluted with Lipiodol, into bleeding gastric ulcers, resulting in successful hemostasis. Soon after the procedure, intraabdominal arterial embolization developed in both patients. One patient survived and the other died. Based on these experiences, we would like to warn gastrointestinal endoscopists to be alert to these fatal complications, and we propose that less diluted Histoacryl seems to be preferable in cases of bleeding peptic ulcers.

Publication types

  • Case Reports

MeSH terms

  • Celiac Artery*
  • Embolism / chemically induced*
  • Embolism / diagnostic imaging
  • Embolization, Therapeutic / adverse effects*
  • Enbucrilate / adverse effects
  • Enbucrilate / analogs & derivatives*
  • Gastroscopy
  • Hepatic Artery*
  • Humans
  • Injections, Intra-Arterial
  • Male
  • Middle Aged
  • Peptic Ulcer Hemorrhage / pathology
  • Peptic Ulcer Hemorrhage / therapy*
  • Stomach Ulcer / pathology
  • Stomach Ulcer / therapy*
  • Tissue Adhesives / adverse effects*
  • Tomography, X-Ray Computed

Substances

  • Tissue Adhesives
  • Enbucrilate