A Rare Case of Gastric Perforation Secondary to Endoscopic Glue Injection for Gastric Varices

Abstract

Gastric perforation is very rare. Gastric perforation following endoscopic glue injection for gastric varices (GVs) in patients with portal hypertension (PHT) has not been documented till date. They are associated with significant morbidity and mortality. We present a glue injection-induced gastric perforation in patients with PHT that has been treated with primary closure at our institution. To the best of our knowledge, this is the first case report of such complication following endoscopic glue injection for GVs. Such site of glue-induced perforation has not been reported in literature till date. A 38-year-old male patient having cirrhosis of liver with PHT underwent repeated upper gastrointestinal (GI) endoscopic procedures for recurrent upper GI bleed. After 20 days of third endoscopic procedure in which he had undergone glue injection for GVs, patient developed abdominal pain and abdominal radiograph was suggestive of bowel perforation. Emergency laparotomy was performed that showed gastric perforation near to glue injection site which was repaired with primary closure at our institution. Complication such as glue injection-induced gastric perforation has not yet been documented. It is potentially life-threatening. Early recognition may lead to a better prognosis through earlier intervention.

Keywords

perforation - gastric varices - glue injection

Publikationsverlauf

Artikel online veröffentlicht:
04. März 2021

• References

• 1 Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W. Practice Guidelines Committee of the American Association for the Study of Liver Diseases, Practice Parameters Committee of the American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007; 46 (03) 922-938
• 2 Qureshi W, Adler DG, Davila R. et al. Standards of Practice Committee. ASGE Guideline: the role of endoscopy in the management of variceal hemorrhage, updated July 2005. Gastrointest Endosc 2005; 62 (05) 651-655
• 3 de Franchis R, Baveno V. Baveno V Faculty. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2010; 53 (04) 762-768
• 4 Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology 1992; 16 (06) 1343-1349
• 5 Akahoshi T, Hashizume M, Shimabukuro R. et al. Long-term results of endoscopic Histoacryl injection sclerotherapy for gastric variceal bleeding: a 10-year experience. Surgery 2002; 131 (Suppl. 01) S176-S181
• 6 Evrard S, Dumonceau JM, Delhaye M, Golstein P, Devière J, Le Moine O. Endoscopic Histoacryl obliteration vs. propranolol in the prevention of esophagogastric variceal rebleeding: a randomized trial. Endoscopy 2003; 35 (09) 729-735
• 7 Seewald S, Ang TL, Imazu H. et al. A standardized injection technique and regimen ensures success and safety of N-butyl-2-cyanoacrylate injection for the treatment of gastric fundal varices (with videos);. Gastrointest Endosc 2008; 68 (03) 447-454
• 8 Cheng LF, Wang ZQ, Li CZ, Lin W, Yeo AE, Jin B. Low incidence of complications from endoscopic gastric variceal obturation with butyl cyanoacrylate. Clin Gastroenterol Hepatol 2010; 8 (09) 760-766
• 9 Al-Hillawi L, Wong T, Tritto G, Berry PA. Pitfalls in Histoacryl glue injection therapy for oesophageal, gastric and ectopic varices: a review. World J Gastrointest Surg 2016; 8 (11) 729-734
• 10 Battaglia G, Morbin T, Patarnello E, Ancona E, Merkel C, Corona M. Visceral fistulae as a complication of sclerotherapy for oesophageal and gastric varices using isobutyl-2-cyanoacrylate. Gastrointest Endosc 2000; 52: 267-270