Cyanoacrylate Treatment of Gastric Varices Case Study 3: Acute Gastric Variceal Bleeding After Surgical Shunt

Background

A 71-year-old male with cryptogenic cirrhosis and hepatocellular carcinoma was transferred from an outlying hospital with acute GI bleeding. He underwent portal decompressive surgery one year earlier for variceal bleeding. Urgent endoscopy revealed a large multilobulated fundal varix with active spurting.

Treatment:

The glue was injected close to the bleeding point. Active bleeding ceased, leaving a glue plug at the bleeding site.

Outcome:

Over the subsequent month, the patient did well without further bleeding. Unfortunately, he missed his follow-up endoscopy at one month and did not undergo additional injections to obliterate all of his large fundal varices. The patient moved back to Southern California and died after a massive recurrent GI bleed. The case illustrates the importance of obliterating all visible gastric varices.