Complete gastric wall necrosis after endoscopic sclerotherapy for a gastric ulcer with visible arterial stump

Deutsche medizinische Wochenschrift
W ScharnkeW Schumm

Abstract

A 43-year-old man with a gastric ulcer was admitted because of sudden onset of epigastric pain, cold sweats and dizziness. He had tachycardia (100/min); his blood pressure was 120/80 mm Hg: his epigastrium was tender to palpation. There were no tarry stools. Haemoglobin concentration was 12.7 g/dl. WBC count 17,900/microliter. Gastroscopy revealed residual haematin and an ulcer with an arterial stump at the angular fold. 3 ml epinephrine, diluted 1:20,000, and 13 ml of 1% polidocanol were injected around the arterial stump, most of the latter solution flowing back into the gastric lumen from the rather hard ulcer base. Haematemesis four days later necessitated laparotomy followed by gastrectomy with reconstruction and a Roux-Y anastomosis because of complete necrosis of the gastric wall. Histological examination of the surgical specimen showed chronic scarred gastric ulcer and ulcerating pangastritis with haemorrhagic necrosis of the wall and associated peritonitis, caused by accidental injection of polidocanol into the artery. Since the tissue-sparing injection of epinephrine, fibrin glue or salt solution is alone effective in the endoscopic treatment of bleeding gastroduodenal ulcers, polidocanol should not be injected as well.

Citations

Jul 16, 2014·Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver·Jérémie JacquesDenis Sautereau
Mar 19, 2008·Best Practice & Research. Clinical Gastroenterology·Lars Aabakken
Sep 16, 2008·Best Practice & Research. Clinical Gastroenterology·Lars Aabakken

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