title: Pyogenic portal vein thrombosis as a reservoir of persistent septicemia after cyanoacrylate injection for bleeding gastric varices.
abstract: Gastric variceal bleeding is a serious complication of liver cirrhosis. A recent consensus suggested that endoscopic injection of tissue glue for gastric variceal obliteration (GVO) should be the first choice for treatment of acute gastric variceal bleeding. Following the widespread use of GVO, more severe complications such as needle cementation, fistula formation, embolic sequels, recurrent septicemia, etc., have been reported. We present the first case of GVO-complicated pyogenic portosplenic vein thrombosis which led to persistent Klebsiella pneumoniae septicemia. The foreign body of a glue plug offers an ideal surface for bacterial colonization which becomes a reservoir for continuous bacterial dissemination. The mechanism was proven by ribotyping of the microorganism and postmortem pathology.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chen-Jung
authors.initials: CJ
authors.lastname: Chang
authors.forename: Yih-Tsong
authors.initials: YT
authors.lastname: Shiau
authors.forename: Te-Li
authors.initials: TL
authors.lastname: Chen
authors.forename: Ming-Chih
authors.initials: MC
authors.lastname: Hou
authors.forename: Chih-Hao
authors.initials: CH
authors.lastname: Sun
authors.forename: Wei-Chih
authors.initials: WC
authors.lastname: Liao
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.forename: Shou-Dong
authors.initials: SD
authors.lastname: Lee
mesh_terms: D003487:Cyanoacrylates / Q000008:administration & dosage / Q000009:adverse effects*; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D018805:Sepsis / Q000209:etiology*; D014014:Tissue Adhesives / Q000008:administration & dosage / Q000009:adverse effects*; D020246:Venous Thrombosis / Q000209:etiology*
chemical_list: D003487:Cyanoacrylates; D014014:Tissue Adhesives