Assuntos
Embucrilato , Hemorragia Gastrointestinal , Adesivos Teciduais , Varizes , Humanos , Embucrilato/administração & dosagem , Embucrilato/efeitos adversos , Varizes/terapia , Varizes/complicações , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Adesivos Teciduais/administração & dosagem , Reto/irrigação sanguínea , Masculino , Hemostase Endoscópica/métodos , Pessoa de Meia-Idade , Feminino , Colonoscopia/métodosRESUMO
BACKGROUND: Hemorrhage associated with varices at the site of choledochojejunostomy is an unusual, difficult to treat, and often fatal manifestation of portal hypertension. So far, no treatment guidelines have been established. CASE SUMMARY: We reported three patients with jejunal varices at the site of choledochojejunostomy managed by endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoacrylate injection at our institution between June 2021 and August 2023. We reviewed all patient records, clinical presentation, endoscopic findings and treatment, outcomes and follow-up. Three patients who underwent pancreaticoduodenectomy with a Whipple anastomosis were examined using conventional upper gastrointestinal endoscopy for suspected hemorrhage from the afferent jejunal loop. Varices with stigmata of recent hemorrhage or active hemorrhage were observed around the choledochojejunostomy site in all three patients. Endoscopic injection of lauromacrogol/α-butyl cyanoacrylate was carried out at jejunal varices for all three patients. The bleeding ceased and patency was observed for 26 and 2 months in two patients. In one patient with multiorgan failure and internal environment disturbance, rebleeding occurred 1 month after endoscopic sclerotherapy, and despite a second endoscopic sclerotherapy, repeated episodes of bleeding and multiorgan failure resulted in eventual death. CONCLUSION: We conclude that endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoacrylate injection can be an easy, effective, safe and low-cost treatment option for jejunal varicose bleeding at the site of choledochojejunostomy.
Assuntos
Coledocostomia , Hemorragia Gastrointestinal , Jejuno , Escleroterapia , Varizes , Humanos , Masculino , Varizes/terapia , Varizes/cirurgia , Coledocostomia/métodos , Coledocostomia/efeitos adversos , Escleroterapia/métodos , Escleroterapia/efeitos adversos , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Hemorragia Gastrointestinal/diagnóstico , Jejuno/cirurgia , Jejuno/irrigação sanguínea , Pessoa de Meia-Idade , Resultado do Tratamento , Feminino , Idoso , Embucrilato/administração & dosagem , Embucrilato/efeitos adversos , Hipertensão Portal/cirurgia , Hipertensão Portal/complicações , Hipertensão Portal/diagnóstico , Soluções Esclerosantes/administração & dosagem , Soluções Esclerosantes/efeitos adversos , Polidocanol/administração & dosagem , Polidocanol/uso terapêutico , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/métodos , Endoscopia Gastrointestinal/métodosAssuntos
Falso Aneurisma , Embolização Terapêutica , Embucrilato , Humanos , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Embucrilato/administração & dosagem , Embucrilato/efeitos adversos , Resultado do Tratamento , Masculino , Fatores de Tempo , Feminino , Remoção de Dispositivo , Pessoa de Meia-IdadeRESUMO
VenaSealTM is composed of a cyanoacrylate adhesive compound often utilized for chronic venous stasis treatment. Rare case reports of hypersensitivity reactions to this compound exist. We present the first case of dermatographism and angioedema after utilization of VenaSealTM successfully treated via high dose antihistamines. We also present a case of type IV hypersensitivity to VenaSealTM, a cyanoacrylate, occurring in a patient with known meth(acrylate) allergy indicating a possible cross reactivity between these acrylate groups.
Assuntos
Embucrilato , Hipersensibilidade , Varizes , Insuficiência Venosa , Humanos , Embucrilato/efeitos adversos , Varizes/terapia , Resultado do Tratamento , Veia Safena , Cianoacrilatos/efeitos adversos , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/terapiaRESUMO
PURPOSE: To evaluate midterm results of whether the strategy to occlude target lumbar arteries using n-butyl-2-cyanoacrylate (nBCA) injection during endovascular aneurysm repair (EVAR) reduced the incidence of Type II endoleak (T2EL) after EVAR. MATERIALS AND METHODS: Between 2013 and 2020, 187 patients underwent EVAR; 106 in the treatment group received nBCA injection during EVAR, whereas 81 in the historical control group did not. The incidence of T2EL at 7 days, need for reintervention, and post-EVAR aneurysmal shrinkage were compared between the groups. RESULTS: Between the treatment group and the control group, significant differences were achieved in the incidence of T2EL (2.8% vs 28.4%; P < .0001) and decreased aneurysmal diameter was observed at 1 year after EVAR (-5.2 vs -3.8 mm; P = .034). In multivariate analysis, nBCA injection (odds ratio [OR], 0.04; P = .001) and younger age (OR, 0.92; P = .036) were significantly associated with a reduced incidence of T2EL. As a possible adverse event associated with nBCA injection, 2 cases of transient lower-limb motor dysfunction (1.9%) were observed. Propensity score analysis revealed that the treatment group had a significantly lower incidence of T2EL than that in the control group (P = .0002) even though there was no difference in the incidence of inferior mesenteric artery coil embolization between the groups. The survival rate without aneurysm sac enlargement (100.0% vs 69.8%; P = .014) and the reintervention-free rate (100.0% vs 63.1%; P = .034) in the treatment group were significantly higher than those in the control group. CONCLUSIONS: Concomitant nBCA injection can provide durable EVAR without T2EL, as supported by the avoidance of reintervention associated with aneurysm sac enlargement.
Assuntos
Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , Embucrilato , Endoleak , Correção Endovascular de Aneurisma , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Implante de Prótese Vascular/efeitos adversos , Embolização Terapêutica/efeitos adversos , Embucrilato/administração & dosagem , Embucrilato/efeitos adversos , Endoleak/etiologia , Endoleak/prevenção & controle , Injeções Intra-Arteriais , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
Las várices gástricas están presentes en cerca de un tercio de los pacientes con hipertensión portal y el sangrado de las mismas representa una causa significativa de mortalidad. El tratamiento de primera línea es la obturación con N-butil-2-cianoacrilato, que si bien es seguro no está libre de complicaciones. Presentamos el caso de un paciente de 61 años de edad con antecedente de cirrosis criptogénica que se presentó a la consulta febril, taquicárdico e hipoxémico después de la obturación endoscópica con N-butil-2-cianoacrilato. Las imágenes mostraron embolia pulmonar bilateral del material obturante. El objetivo de este trabajo es destacar las manifestaciones clínicas y las imágenes de esta situación para ayudar a su diagnóstico precoz y diferenciarla de otras entidades que requieren un tratamiento específico.
Gastric varices occur in one-third of patients with portal hypertension. Bleeding from gastric varices remains a significant cause of death. Currently the first-line of treatment for gastric varices is endoscopic obliteration with N-butyl-2-cyanoacrylate. Though relatively safe, this option has several well-known complications. We report the case of a 61-year-old male patient with cryptogenic cirrhosis, who presented with fever, tachycardia and hypoxemia after endoscopic obliteration with N-butyl-2-cyanoacrylate. Radiographic findings were consistent with pulmonary embolism of the sclerosing substance. The aim of this case report is to emphasize the clinical and radiological findings of this complication in order to distinguish it from other similar medical conditions and prevent a delay in diagnosis.