[Fatal pulmonary embolism after endoscopic embolization of downhill esophageal varix].
METHODS
A 79-year-old man was admitted with a history of recent haematemesis and tarry stools. 4 years before he had undergone a subtotal thyroidectomy for hyperthyroidism.


METHODS
He was anaemic (haemoglobin 7.2 g/dl, haematocrit 23%). At the transition between the upper and middle third of the oesophagus gastroscopy revealed a bleeding oesophageal varix.


METHODS
The bleeding varix was sclerosed with polidocanol. 3 erythrocyte concentrates were administered. Massive bleeding 2 days later was controlled with intravaricose injection of cyanoacrylate (Histoacryl). The patient died 6 weeks later from progressive cardiovascular failure. Autopsy revealed the cause of death as right heart failure with extensive foreign-body pulmonary emboli identified as thrombotic material containing polymerized cyanoacrylate found in the previously injected oesophageal varix. Also discovered was a retrosternal goitre which had compressed the brachiocephalic vein. Cause of the "washing-out" of the cyanoacrylate embolus from the varix into the systemic circulation was an oesophago-varicose collateral circulation in a cranio-caudal direction; this had been formed by the pressure of the retrosternal goitre on the brachiocephalic vein.


CONCLUSIONS
Cyanoacrylate injection into a varix above the lower third of the oesophagus should only be done under strict indication. A similar risk as that described in this case potentially exists in the treatment of acute bleeding from a portosystemic varicose circulation.
Tsokos
M
M
Institut für Rechtsmedizin, Universität Hamburg.
Bartel
A
A
Schoel
R
R
Rabenhorst
G
G
Schwerk
W B
WB
D000368:Aged; D001344:Autopsy; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D004659:Enbucrilate / Q000008:administration & dosage; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005547:Foreign Bodies / Q000150:complications* / Q000209:etiology / Q000473:pathology; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D006801:Humans; D008297:Male; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000008:administration & dosage; D011655:Pulmonary Embolism / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D012597:Sclerosing Solutions / Q000008:administration & dosage
D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols; D004659:Enbucrilate
Tödliche Lungenarterienembolie nach endoskopischer Embolisation einer "Downhill-Varize" des Osophagus.