Endoscopic injection of Histoacryl® in the treatment of recurrent hematuria secondary to bladder varices

Abstract

Macroscopic haematuria involving bladder varices is a rare presentation to Emergency Department. Its presentation warrants immediate diagnosis and management to prevent severe anaemia and hypovolaemia. Injection therapy may be an option that can be offered as an alternative procedure to treat gross hematuria. It is considered less invasive when compared to an open surgery especially in high morbidity patients. We described an alternative treatment modality in the treatment of bleeding bladder varices using endoscopic injection of Histoacryl (N-butyl-2-Cyanoacrylate). This case report describes a female patient who presented to the ED with bleeding bladder varices secondary to portal hypertension in an ileal augmented bladder. The report discusses an alternative treatment modality to treat bleeding bladder varices using endoscopic injection of Histoacryl (N-butyl-2-Cyanoacrylate). Macroscopic haematuria is a common presentation to the Emergency Department (ED). Nevertheless, haematuria secondary to urinary bladder varices is an unusual presentation. Bladder varices secondary to portal hypertension is rare since the bladder wall is not the usual collateral route for venous splanchnic blood flow. Bladder varices may occur in patients with portal hypertension in circumstances where the normal splanchnic collaterals fail to develop due to prior obliteration from treatments such as surgery, sclerotherapy or ligation. The second probability is when the anatomy of the venous drainage of the bladder is altered from surgery such as bladder augmentation with a bowel segment. Histoacryl^® injection therapy can be regarded as an effective alternative in the management of patient with bleeding bladder varices.