Internal and Emergency Medicine

, Volume 13, Issue 5, pp 817–819 | Cite as

Cerebral infarction following cyanoacrylate endoscopic therapy of duodenal varices in a patient with a patent foramen ovale

  • Baptiste Abbar
  • Damien Vimpere
  • Sherine Khater
  • Christophe Cellier
  • Jean-Luc DiehlEmail author

We report here a very severe complication after endoscopic N-butyl-2-cyanoacrylate glue sclerotherapy of an ectopic gastrointestinal varix in a 52-year-old man. The patient was admitted to the medical ICU for acute digestive tract bleeding with hematemesis, melena, and shock. The medical history mainly consisted of cirrhosis secondary to hepatitis B virus and non-alcoholic steato hepatitis (NASH).

An upper gastrointestinal endoscopy found stage II esophageal varices with red color signs. A band ligation was performed with primary endoscopic success. Recurrent massive bleeding occurred 2 days later. After hemodynamic stabilization, an upper gastrointestinal endoscopy was again performed, following general recommendations [1]. No further oesophageal varix bleeding was evidenced. However, a duodenal varix with red color sign was found in the 2nd part of the duodenum. Red color sign of the duodenal varix was characterized by the association of red wale markings with a red spot. An...


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

All procedures performed in the studies were in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from the patient for publication of the manuscript.


  1. 1.
    de Franchis R, on behalf of the Baveno VI Faculty (2015) Expanding consensus in portal hypertension: report of the Baveno VI consensus workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol 63:743–752CrossRefPubMedGoogle Scholar
  2. 2.
    Helmy A, Al Kahtani K, Al Fadda M (2008) Updates in the pathogenesis, diagnosis and management of ectopic varices. Hepatol Int 2:322–334CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Cheng LF, Wang ZQ, Li CZ, Lin WU, Yeo AE, Jin BO (2010) Low incidence of complications from endoscopic gastric variceal obturation with butyl cyanoacrylate. Clin Gastroenterol Hepatol 8:760–766CrossRefPubMedGoogle Scholar
  4. 4.
    Lo GH, Lai KH, Cheng JS, Chen MH, Chiang HT (2001) A prospective, randomized trial of butyl cyanoacrylate injection versus band ligation in the management of bleeding varices. Hepatology 33:1060–1064CrossRefPubMedGoogle Scholar
  5. 5.
    Romero-Castro R, Ellrichmann M, Ortiz-Moyano C et al (2013) EUS-guided coil versus cyanoacrylate therapy for the treatment of gastric varices: a multicentre study (with videos). Gastrointest Endosc 78:711–721CrossRefPubMedGoogle Scholar

Copyright information

© SIMI 2018

Authors and Affiliations

  1. 1.Medical Intensive Care Unit, Hôpital Européen Georges PompidouAssistance Publique-Hôpitaux de ParisParisFrance
  2. 2.Université Paris Descartes, Sorbonne Paris CitéParisFrance
  3. 3.Department of Gastroenterology and Digestive Endoscopy, Hôpital Européen Georges PompidouAssistance Publique-Hôpitaux de ParisParisFrance
  4. 4.INSERM, UMR_S1140: Innovations Thérapeutiques en HémostaseParisFrance
  5. 5.Faculté des Sciences Pharmaceutiques et BiologiquesParis Descartes UniversityParisFrance

Personalised recommendations