Safety of endoscopic N-Butyl-2 Cyanoacrylate injection for the treatment of bleeding gastric varices in children.

OBJECTIVE: To determine the safety and efficacy of N-butyl 2-cyanoacrylate in bleeding gastric varices in children. METHODS: This retrospective observational study was conducted in the Department of Gastroenterology and Pediatric Surgery in Liaquat National Hospital Karachi between January 2010 and January 2017. Gastric fundal varices were obliterated in pediatric population with single shot of N-butyl-2 Cyanoacrylate 0.50ml diluted with 0.50ml of Lipoidal with use of forward-viewing video endoscope with 22-gauge needle. The primary outcome was primary hemostasis, Secondary outcome was complications, re-bleeding and mortality. RESULTS: Thirty patients was included in the study, 18(60%) were male with mean age of 7.12± 2.9 years. Non cirrhotic portal hypertension was the most common etiology in 15 (50%) patients, followed by liver cirrhosis secondary to hepatitis B and D co-infection in 6(20%) patients. Primary hemostasis was achieved in 29 (96.7%), while 3(10%) patients developed re-bleeding after 48 hours, and hemostasis was achieved after second session of endoscopic obliteration. Abdominal pain and fever developed in 3(10%) patients which was managed conservatively. Mortality was observed in 1(3%) of cases due to sepsis after shunt surgery. CONCLUSION: Endoscopic fundal varix obliteration with N Butyl-2 cyanoacrylate was safe and effective in treatment of gastric variceal hemorrhage in children.

Aortoenteric fistula - A fatal cause of gastrointestinal bleeding. Can it be missed? - A case report.

Gastrointestinal (GI) bleeding, is the life threating presentation of many diseases in emergency room. Aortoenteric fistula (AEF) is one of the rare causes of GI bleeding that can be fatal if not diagnosed and treated promptly. We present a case of a86 years old hypertensive male with the history of fresh bleeding per rectum, dizziness, fatigability and palpitation for last 12 hours who came to the emergency room in January 2015 He was stabilized and resuscitated. On lab investigation and abdominal CT scan he was diagnosed as aortic aneurysm with AEF. The related pathology, diagnosis and management of the disorder has been discussed in this case report.

Glue embolism: a rare cause of pulmonary embolism.

N-butyl-2-cyanoacrylate is widely used to sclerose bleeding gastric varices. We report the case of a 65-year-old lady, known case of cirrhosis secondary to hepatitis C infection, who presented to the emergency department with coffee ground vomiting and melena for four days. Gastroscopy showed non-bleeding small esophageal varices, mild portal hypertensive gastropathy and a large gastric fundal varix. Injection sclerotherapy was completed successfully and haemostasis was secured. During the procedure, she was hemodynamically stable with an oxygen saturation of 98%. Immediately after the procedure, she went into cardiopulmonary arrest; cardiopulmonary resuscitation (CPR) was started, but she could not be revived. A provisional diagnosis of pulmonary embolism was made. X-ray chest showed linear hyperdense shadows in both pulmonary arteries and in some of their branches, which were not seen on pre-procedural chest X-ray. The patient died of massive pulmonary embolism as confirmed on X-ray chest.

Transjugular intrahepatic portosystemic stenting in Portal Hypertensive Gastropathy.

Portal Hypertensive Gastropathy (PHG) is a rare cause of upper gastrointestinal bleeding in patients with Chronic Liver Disease (CLD). This is the case report of a 46-year-old female known case of Hepatitis C Virus (HCV) CLD, who presented with melena and coffee ground vomitings for 6 months. Esophagogastroduodenoscopy (EGD) showed PHG while an ultrasound revealed chronic liver disease. The patient had a history of repeated blood transfusions over the last 6 months. She was given propanolol but no benefit occurred. She was referred for transjugular intrahepatic portosystemic stenting (TIPSS) to an interventional radiologist, which was followed by a reduction in PHG and the need for transfusion.