Endoscopic injection of N-butyl-2-cyanoacrylate with Lauromacrogol causing tiny emboli formation in the right atrium: a case report

Background: In previous case reports, ectopic embolism caused by endoscopic cyanoacrylate injection was identified and diagnosed several days after the patient had undergone treatment. It is rare for an embolus to be observed in time for the patient to undergo endoscopic treatment. This may be the first case report in which emboli were immediately observed during endoscopic cyanoacrylate injection. Case presentation A male patient in his mid-40s with gastric variceal hemorrhage developed a decreased blood pressure immediately after cyanoacrylate injection with Lauromacrogol. The patient’s blood pressure was restored after repeated administration of phenylephrine. Multiple tiny emboli entering the pulmonary circulation through the right atrium were observed on echocardiography, which were presumed to have contributed to the patient’s intraoperative hypotension. Postoperatively, the patient did not show any clinical signs of ectopic embolism and was safely discharged on postoperative day 8. Conclusions: Hemodynamic fluctuations after endoscopic cyanoacrylate injection suggest the possibility of microemboli entering the pulmonary circulation. Transthoracic echocardiography can help to promptly detect microemboli.