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Case Reports
. 2013 Sep 14;19(34):5759-62.
doi: 10.3748/wjg.v19.i34.5759.

Cerebral and splenic infarctions after injection of N-butyl-2-cyanoacrylate in esophageal variceal bleeding

Dae-Seong Myung  1 , Cho-Yun Chung, Hyung-Chul Park, Jong-Sun Kim, Sung-Bum Cho, Wan-Sik Lee, Sung-Kyu Choi, Young-Eun Joo
Affiliations
Case Reports

Cerebral and splenic infarctions after injection of N-butyl-2-cyanoacrylate in esophageal variceal bleeding

Dae-Seong Myung et al. World J Gastroenterol. .

Abstract

Variceal bleeding is the most serious complication of portal hypertension, and it accounts for approximately one fifth to one third of all deaths in liver cirrhosis patients. Currently, endoscopic treatment remains the predominant method for the prevention and treatment of variceal bleeding. Endoscopic treatments include band ligation and injection sclerotherapy. Injection sclerotherapy with N-butyl-2-cyanoacrylate has been successfully used to treat variceal bleeding. Although injection sclerotherapy with N-butyl-2-cyanoacrylate provides effective treatment for variceal bleeding, injection of N-butyl-2-cyanoacrylate is associated with a variety of complications, including systemic embolization. Herein, we report a case of cerebral and splenic infarctions after the injection of N-butyl-2-cyanoacrylate to treat esophageal variceal bleeding.

Keywords: Cerebrum; Esophageal varix; Infarction; N-butyl-2-cyanoacrylate; Spleen.

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Figures

Figure 1
Figure 1
Endoscopy showing a large esophageal varix. The varix occupies more than half of the esophageal lumen. The adherent, whitish fibrin plug on top of the varix is considered a site of recent hemorrhage.
Figure 2
Figure 2
Non-contrast brain computed tomography showing multiple high attenuation lesions (arrows). The multiple high attenuation lesions are emboli of the Histoacryl-Lipiodol mixture. The high attenuation lesions were seen in the frontal lobe and the parieto-occipital lobe.
Figure 3
Figure 3
Abdominal computed tomography reveals several wedge-shaped, low attenuation lesions in the spleen, indicating infarction (arrow). A: Computed tomography (CT) before endoscopic treatment; B: CT after endoscopic treatment.
Figure 4
Figure 4
Transcranial Doppler bubble test showing the Doppler flow through the middle cerebral artery. The embolus is clearly represented in the power M-mode (upper panel) as a whitish sloping track. The whitish sloping track means that microemboli disrupt the ultrasonic signal (arrows).
See this image and copyright information in PMC

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