Pulmonary Embolization After Gastric Varices Obliteration

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Pulmonology

Background:

• N-butyl-2-cyanoacrylate (NB2CA) is a common endoscopic treatment for variceal hemorrhage with high success rates.
• Complications, though rare, include esophageal perforation, infection, and embolization.

Observation:

• A 67-year-old male with chronic liver disease presented with gastrointestinal bleeding treated with NB2CA injection for gastric varices.
• Post-procedure, the patient developed acute respiratory failure.
• CT angiography revealed NB2CA emboli within arterial vessels.

Findings:

• The patient required mechanical ventilation and intensive care but experienced complications including hepatic encephalopathy, hepatorenal syndrome, and nosocomial pneumonia.
• Despite initial stabilization, the patient ultimately died.

Implications:

• This case underscores the potential for NB2CA embolization to cause severe, life-threatening respiratory complications.
• A high index of suspicion is crucial for diagnosing NB2CA embolization in patients with respiratory distress post-procedure.
• Careful NB2CA injection technique and patient monitoring are essential to mitigate risks.