Pyogenic portal vein thrombosis as a reservoir of persistent septicemia after cyanoacrylate injection for bleeding gastric varices.
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.
Chang
Chen-Jung
CJ
Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Shiau
Yih-Tsong
YT
Chen
Te-Li
TL
Hou
Ming-Chih
MC
Sun
Chih-Hao
CH
Liao
Wei-Chih
WC
Lin
Han-Chieh
HC
Lee
Shou-Dong
SD
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*
D003487:Cyanoacrylates; D014014:Tissue Adhesives