Pulmonary embolism due to injection of Histoacryl and Lipiodol during endoscopic sclerotherapy of fundic varices

Pulmonary N-butyl-2-cyanoacrylate embolism is one of the potential risks associated with endoscopic obliteration of fundic gastric varices. Due to its uncommon nature, especially in children, no consensus has been proposed on its optimal management. Case report : An 11-year-old boy with a longstanding history of lung- and liver fibrosis with portal hypertension causing hae- matemesis underwent endoscopic therapy for fundic varices. Shortly after injection of 0.5 ml of a N-butyl-2-cyanoacrylate (Histoacryl®) and lipid soluble ethiodized oil (Lipiodol®) mixture, he desaturated with secondary hypotension and bradycardia. Pulmonary embolism was confirmed on chest X-ray. The boy was successfully treated conservatively. Clinical symptoms subsided and he was discharged after three days. Pulmonary infiltrations persisted for two weeks. Conclusion : Patients including children undergoing obliteration of gastric varices with Histoacryl and Lipiodol should be subjected to a close follow-up. Coexisting lung conditions may enhance the risk of pulmonary embolism and can also influence the outcome. (Acta gastroenterol. belg., 2008, 71, 387-389).