ºÚÁÏÍø

Abstract

Upper gastrointestinal bleeding can be managed with a number of different endoscopic techniques. However, a small number of patients have persistent bleeding requiring radiological or surgical intervention. Herein, we present a case of massive duodenal ulcer bleeding that was managed by spraying cyanoacrylate glue on the duodenal ulcer after failure of multiple modalities. A 44-year old female with multiple comorbidities including metastatic breast cancer presented with melena. She was not using any anti-steroidal or anticoagulant medications. At admission, the heart rate was 132 beats per min, supine blood pressure was 81/52 mmHg and FiO2 was 99%. An esophagogastroduodenoscopy (EGD) revealed an actively bleeding duodenal ulcer, managed with injection of 10 ml of epinephrine (1:10,000) and by applying three endoclips and she was maintained on proton pump inhibitor infusion. However, the bleeding recurred within 24 hours, with hemodynamic instability, bright red blood in the naso-gastric tube and reduction in the Hb. A repeat EGD revealed active bleeding from the ulcer. Argon plasma coagulation was applied repeatedly on the ulcer area that failed to control the profuse bleeding. Subsequently, cyanoacrylate (Histoacryl�®) was sprayed on to the ulcer surface that achieved immediate hemostasis. No further bleeding occurred and the patient was discharged from the hospital after 7 days. This case demonstrates the potential efficacy of cyanoacrylate glue spray on the ulcer surface for hemostasis in patients with difficult-to-control bleeding failing conventional endoscopic therapies. Prospective studies with a larger number of patients are required to evaluate the role of the cyanoacrylate spray technique for ulcer bleeding.

Biography

Omar Naji Alnabihi is currently a Medical Intern at King Abdulaziz Medical City in Saudi Arabia. He has completed his graduation from the College of Medicine from King Saudi bin Abdulaziz University for Health Sciences in Saudi Arabia.