引起心包炎的非心脏手术并发症

Q4 Medicine

JACC. Case reports Pub Date : 2025-10-08 DOI:10.1016/j.jaccas.2025.105338

Grace Hagan MD , Teodora Donisan MD , Hayan Jouni MD , Sushil A. Luis MD

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引用次数: 0

摘要

内镜下氰基丙烯酸酯注射（ECI）是胃静脉曲张出血的标准治疗方法。以前没有继发于ECI进入心包的心包炎病例。病例总结：一名55岁女性，因胰腺神经内分泌肿瘤继发胃静脉曲张出血并累及脾静脉而行ECI，导致心包间隙直接注射后继发心包炎。这种异物引起的心包炎的处理不在当前指南的范围之内。基于已知的氰基丙烯酸酯的炎症性和不溶性，实施了标准的抗炎治疗。尽管长期抗炎治疗，该患者在手术后数月仍有症状性心包炎以及心脏影像学炎症改变。ECI术后心包炎是一种少见但严重的并发症。必须监测一系列炎症标志物和心脏成像，以及监测症状消退，以评估是否需要延长抗炎治疗或心包切除术。

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Noncardiac Procedural Complication Resulting in Pericarditis

Background

Endoscopic cyanoacrylate injection (ECI) is a standard management for bleeding gastric varices. There have been no previous cases of pericarditis secondary to ECI into the pericardium.

Case Summary

A 55-year-old woman with bleeding gastric varices secondary to pancreatic neuroendocrine tumor with splenic vein involvement underwent ECI, which resulted in postprocedural pericarditis secondary to direct injection into the pericardial space.

Discussion

Management of this foreign substance–induced pericarditis is outside the realm of current guidelines. Based on the known inflammatory and insoluble nature of cyanoacrylate, standard anti-inflammatory therapies were implemented. Despite prolonged anti-inflammatory therapy, this patient continues to have symptomatic pericarditis as well as inflammatory changes on cardiac imaging months after her procedure.

Take-Home Messages

Postprocedural pericarditis from ECI is an infrequent yet serious complication. It is imperative to monitor serial inflammatory markers and cardiac imaging, as well as to monitor symptom resolution, to assess the need for prolonged anti-inflammatory tapers or pericardiectomy.

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