Sengstaken–Blakemore tube: an unusual complication
13 December 2013 (online)
Acute variceal bleeding is a life-threatening event. Endoscopic band ligation is currently the recommended treatment ; however, in the case of reduced variceal volume, injection therapy with polidocanol or Histoacryl may be more appropriate. If both endoscopic options fail, placement of a Sengstaken–Blakemore tube should be considered , although other endoscopic therapies can be used .
A 54-year-old man with a known history of compensated alcoholic cirrhosis presented in the emergency room with acute hematemesis. The vital signs were stable and laboratory workup showed mild anemia and thrombocytopenia. Upper endoscopy revealed a peptic esophagitis with confluent ulceration and a spurting variceal hemorrhage in the cardia. After injection of 10 ml of 1 % polidocanol, that did not control the bleeding, a Sengstaken–Blakemore tube (Cliny type 42; Create Medic Co, Yokohama, Japan) was positioned, with 250 ml of air insufflated in the gastric balloon and 80 ml in the esophageal balloon. For traction maintenance, a 500-ml bag of saline was used, as was regular practice. However, after 10 minutes part of the tube suddenly became exteriorized ([Fig. 1]). As the video demonstrates ([Video 1]) the extremity with the deflated balloon, because of spontaneous transection 3 cm proximally to the balloon insertion, was still in place. It was decided to remove the tube with a snare. On revision there was no active bleeding, hence no treatment was carried out.
The use of a Sengstaken–Blakemore tube is increasingly rare, mostly because of the high incidence of complications, such as aspiration pneumonia, airway obstruction, pressure necrosis of the mucosa, esophageal rupture, and cardiac inflow obstruction   . To our knowledge this is the first video showing the extraction of a Sengstaken–Blakemore tube that had transected probably because of a manufacturing defect. To prevent this situation a careful assessment of the tube must be made before placement. Besides the very successful resolution using a standard endoscopic extraction procedure, we emphasize the rarity of the video images of this unusual situation.
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