Noncardiac Procedural Complication Resulting in Pericarditis

Endoscopic cyanoacrylate injection (ECI) is a standard management for bleeding gastric varices. There have been no previous cases of pericarditis secondary to ECI into the pericardium.

A 55-year-old woman with bleeding gastric varices secondary to pancreatic neuroendocrine tumor with splenic vein involvement underwent ECI, which resulted in postprocedural pericarditis secondary to direct injection into the pericardial space.

Management of this foreign substance-induced pericarditis is outside the realm of current guidelines. Based on the known inflammatory and insoluble nature of cyanoacrylate, standard anti-inflammatory therapies were implemented. Despite prolonged anti-inflammatory therapy, this patient continues to have symptomatic pericarditis as well as inflammatory changes on cardiac imaging months after her procedure.

Postprocedural pericarditis from ECI is an infrequent yet serious complication. It is imperative to monitor serial inflammatory markers and cardiac imaging, as well as to monitor symptom resolution, to assess the need for prolonged anti-inflammatory tapers or pericardiectomy.