Pulmonary Glue Embolization after Endoscopic Treatment of Bleeding Sigmoid Colon Varices

A 58-year-old cirrhotic man presented with painless severe hematochezia. Physical examination revealed pallor, pitting pedal edema, and palpable hepatosplenomegaly. Sigmoidoscopy after resuscitation revealed a tortuous, bluish structure protruding into the lumen, suggestive of a large sigmoid colon varix with stigmata of recent hemorrhage and white nipple sign (Figure 1). Undiluted N-butyl-2-cyanoacrylate glue (2 mL) was injected into the varices, and an intravenous (IV) bolus of terlipressin (2 mg) achieved hemostasis. Six hours later, the patient developed shortness of breath, severe bilateral pleuritic chest pain, and hypoxemia. Plain x-ray of the chest revealed acute, bilateral, subsegmental, linear, hyperdense shadows within both main pulmonary arteries and branches, suggestive of glue embolization (Figure 2). The patient was successfully managed conservatively with high-flow oxygen and intensive-care monitoring. Two weeks later, repeat sigmoidoscopy revealed complete obliteration of the sigmoid colon varix.