Siyanoakrilat ilişkili pulmoner emboli; Olgu sunumu

Sirotik hastaların %50’ye yakınında özofagus ve gastrik varisler gelişir. Varisli siroz hastalarında dekompansasyon bulgusu olarak varis kanaması görülebilmektedir. Kanamalar sıklıkla özofageal varis kaynaklı kanamalardır. Gastrik varisler daha nadir kanar; ancak daha ciddi ve mortalitesi yüksek kanamalara neden olurlar. Gastrik varisler özofagus varisleri ile karşılaştırıldığında daha geniş çapta ve submukozal alanda daha derine uzanım gösterebilirler. Bu nedenle özofagus varisleri için yapılan standart endoskopik tedaviler büyük oranda etkisizdir. Siyanoakrilat tedavisinde septik ve embolik komplikasyonlar görülebildiği bildirilmiştir. Olgumuzda akut gastrik varis kanaması ile başvuran siroz hastasında siyanoakrilat tedavisi sonrası gelişen pulmoner emboli olgusu sunulmuştur.

Anahtar Kelimeler:

Varis, siyanoakrilat, emboli

Cyanoacrylate associated pulmonary embolism: A case report

Up to 50% of cirrhotic patients develop esophageal and gastric varices. Varicose bleeding may develop as a sign of decompensation in patients with cirrhosis with varicose veins. Bleeding is often caused by esophageal varices. Gastric varices bleed less frequently, but they cause more serious and high-mortality bleeding. Compared to esophageal varices, gastric varices may extend more widely and deeper into the deep submucosal area. Therefore, standard endoscopic treatments for esophageal varices are largely ineffective. Septic and embolic complications have been reported from cyanoacrylate treatment. In our case, a case of pulmonary embolism that developed after cyanoacrylate treatment in a cirrhosis patient who presented with acute gastric variceal bleeding is presented.

Keywords:

Gastric varices, cyanoacrylate, thromboembolism,

PDF

___

1. North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. N Engl J Med 1988;319:983-9.
2. Garcia-Tsao G, Abraldes JG, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology 2017;65:310-35.
3. Reverter E, Tandon P, Augustin S, et al. A MELD-based model to determine risk of mortality among patients with acute variceal bleeding. Gastroenterology 2014;146:412-19.
4.Tapper EB, Friderici J, Borman ZA, et al. A multicenter evaluation of adherence to 4 major elements of the Baveno Guidelines and outcomes for patients with acute variceal hemorrhage. J Clin Gastroenterol 2018;52:172-7.
5. Smith JL, Graham DY. Variceal hemorrhage: a critical evaluation of survival analysis. Gastroenterology 1982;82:968-73.
6. de Dombal FT, Clarke JR, Clamp SE, et al. Prognostic factors in upper G.I. bleeding. Endoscopy 1986;18(Suppl 2):6-10.
7. Mishra SR, Sharma BC, Kumar A, Sarin SK. Primary prophylaxis of gastric variceal bleeding comparing cyanoacrylate injection and beta-blockers: a randomized controlled trial. J Hepatol 2011;54:1161-7.
8. Ryou M, Thompson CC. Tissue adhesives: A Review, Techniques in Gastrointestinal Endoscopy 2006;8:33-7.
9. Amin P, Pannu T, Mohamed R, Watson K. Nonthrombotic pulmonary embolism secondary to cyanoacrylate embolization of gastric varices. CMAJ 2022;194:E336-7.
10. Watanabe K, Kimura K, Matsutani S, et al. Portal hemodynamics in patients with gastric varices: a study in 230 patients with esophageal and/or gastric varices using portal vein catheterization. Gastroenterology 1988;95:434-40.
11. Asah D, Raju S, Ghosh S, et al. Nonthrombotic pulmonary embolism from inorganic particulate matter and foreign bodies. Chest 2018;153:1249-65.