Fatal acute pulmonary embolism following endoscopic cyanoacrylate injection for gastric fundal varices

Acute gastric variceal bleeding is a rare but serious complication of portal hypertension. Initial therapy for bleeding gastric varices focuses on acute hemostasis. In this regard, endoscopic cyanoacrylate injection (ECI) is the first-line approach. Cyanoacrylate diluted with Lipiodol acts as a tissue adhesive that polymerizes on contact with blood. Glue-induced pulmonary embolism is a very rare but severe complication of ECI. This paper describes a case of fatal glue pulmonary embolism during ECI for prevention of bleeding from gastric fundal varices in a patient with polycythemia vera and the presence of portosystemic shunts.