Resección quirúrgica de tapón de cianoacrilato variceal infectado posterior a esclerosis endoscópica de várices gástricas. Caso clínico

Abstract

Removal of an infected gastric cyanoacrylate plug. Report of one caseIn patients with actively bleeding gastric varices, the treatment of choice is the endoscopic use of sclerosing agents such as cyanoacrylate. We report a 69-year-old man who, after being treated with cyanoacrylate, suffered from recurrent febrile episodes. After an extensive study and broad-spectrum antibiotic treatment, discarding other presumably infectious focus, the superinfection of the cyanoacrylate plug was suspected, and its surgical removal was decided. A partial gastrectomy of the gastric fundus, a splenectomy, and a distal pancreatectomy were performed. The patient evolved without fever and without new episodes of bacteremia, but with decompensation of his cirrhosis manifested by ascites, spontaneous bacterial peritonitis, pneumonia, and collections in the pancreatic bed. These complications were managed with medical treatment consisting in a long course of broad-spectrum antibiotics. Thereafter, the patient evolved satisfactorily.

Surgical Treatment of Persistent Pseudomonas aeruginosa Bacteraemia After n-Butyl-2-cyanoacrylate for Gastric Bleeding Varices

“…Variceal cyanoacrylate injection has been reported to cause transient bacteraemia with no subsequent complications [ 4 ]. However, recurrent bacteraemia is a rare complication and only ten cases have been reported to the date in the literature [ 6 – 13 ]. Three of the ten reported cases died despite effective antibiotics.…”

“…Furthermore, PET-CT scan has been only performed in three other cases and it should be considered as a useful tool for its diagnosis [ 7 , 11 , 13 ].…”

“…Furthermore, local vessel obstruction, systemic embolization, and fever with transient bacteraemia have been described [ 4 , 5 ]. Persistent bacteraemia has been reported and it is considered an unusual complication with a moderate-high mortality rate [ 6 – 13 ]. The physiopathology is not entirely understood but it could be explained by the fact that NCBA forms a large conglomerate providing an ideal niche for bacterial growth.…”