Barium-impregnated fibrin glue: application to a bleeding duodenal sinus
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This study explored using fibrin glue to treat upper gastrointestinal bleeding from a duodenal sinus in a Crohn's disease patient. Fibrin glue successfully stopped bleeding, offering a novel endoscopic treatment option.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Biomaterials in Medicine
Background:
- Crohn's disease can lead to complex fistulas and surgical complications.
- Upper gastrointestinal bleeding from duodenal sinus poses significant management challenges.
- High-risk patients often have limited treatment options for refractory bleeding.
Observation:
- A patient with Crohn's disease experienced refractory upper GI bleeding from a duodenal sinus post-surgery.
- Endoscopic management with fibrin glue mixed with barium was employed due to high reoperation risks.
- The procedure was performed under endoscopic guidance.
Findings:
- Fibrin glue successfully controlled the duodenal sinus bleeding.
- Barium-impregnated fibrin glue allowed for effective radiological surveillance.
- The patient experienced no further gastrointestinal bleeding post-treatment.
Implications:
- Fibrin glue represents a potential minimally invasive therapeutic option for duodenal sinus bleeding.
- Endoscopic application of fibrin glue may be beneficial in high-risk surgical patients.
- Further research is warranted to establish the efficacy and mechanism of fibrin glue in this context.
Abstract:
A 64-year-old man with Crohn's disease who had undergone repair of an ileovesical fistula and ileoileostomy had numerous postoperative complications related to sepsis and wound healing. Subsequently, upper gastrointestinal bleeding developed, and the site was identified as a duodenal sinus. Medical management was unsuccessful in controlling the bleeding. Because of the considerable risk associated with reoperation in this seriously ill patient, approval was obtained from the Food and Drug Administration to use fibrin glue in an attempt to prevent further bleeding. The glue was mixed with barium and placed in the duodenal sinus under endoscopic guidance. The barium-impregnated glue facilitated follow-up surveillance with abdominal roentgenography. The patient had no further gastrointestinal bleeding. Further clinical and experimental studies should be conducted to determine the mechanism of action and the efficacy of this application of fibrin glue.