Fouad Haddad, Aicha Darif*, Zineb Boukhal, Fatima Zahra El rhaoussi, Mohamed Tahiri, Wafaa Hliwa, Ahmed Bellabeh and Wafae Badre

Gastroenterology and Hepatology Department, Ibn Rochd University Hospital Center of Casablanca, Morocco

*Corresponding Author: Aicha Darif, Gastroenterology and Hepatology Department, Ibn Rochd University Hospital Center of Casablanca, Morocco.

Received: August 14, 2025; Published:August 24, 2025

Abstract

In cirrhosis, hemorrhage from ruptured rectal varices can complicate portal hypertension syndrome. This is a rare complication, but it can be life-threatening. The management of active bleeding from rectal varices is not codified. There are no large series; the literature consists only of clinical cases. Generally, after diagnosis by recto-sigmoidoscopy, treatment is endoscopic (sclerotherapy or elastic ligation). We report the case of a 60-year-old cirrhotic patient admitted for massive hematochezia due to rupture of a rectal varicose vein. Treatment was endoscopic injection of N-Butyl-2-Cyanoacrylate, resulting in effective hemostasis without recurrence of bleeding.

Keywords: Hypertension; portal; varices; rectal bleeding; N-Butyl-2-Cyanoacrylate

References

1. Franchis R., et al. “Baveno VII Faculty. Baveno VII - Renewing consensus in portal hypertension”. Journal of Hepatology 4 (2022): 959‑974.
2. Sato T., et al. “Clinicopathological features and treatment of ectopic varices with portal hypertension”. International Journal of Hepatology (2011): 960720.
3. Shudo R., et al. “Clinical study comparing bleeding and nonbleeding rectal varices”. Endoscopy3 (2002): 189‑194.
4. JLE - Hépato-Gastro and Oncologie Digestive - Diagnostic et prise en charge des varices rectales (2025).
5. Masson E. “Comment prévenir et traiter les hémorragies par varices gastriques, ou ectopiques ou par gastropathie congestive” (2025).
6. Chawla Y and Dilawari JB. “Anorectal varices--their frequency in cirrhotic and non-cirrhotic portal hypertension”. Gut 3 (1991): 309‑311.
7. Shiraki M., et al. “Rupture of rectal varices treated with endoscopic variceal ligation”. Surgical Laparoscopy Endoscopy and Percutaneous Techniques 5 (2004): 295‑299.
8. Katz JA., et al. “Recurrent bleeding from anorectal varices: successful treatment with a transjugular intrahepatic portosystemic shunt”. The American Journal of Gastroenterology 7 (1993): 1104‑1107.
9. Hosking SW., et al. “Anorectal varices, haemorrhoids, and portal hypertension”. Lancet London England 8634 (1989): 349‑352.
10. Weiserbs DB., et al. “Control of massive hemorrhage from rectal varices with sclerotherapy”. Gastrointestinal Endoscopy 6 (1986): 419‑421.
11. Dhiman RK., et al. “Endoscopic ultrasonographic evaluation of the rectum in cirrhotic portal hypertension”. Gastrointestinal Endoscopy 5 (1993): 635‑640.
12. Tsynman DN., et al. “Novel use of EUS to successfully treat bleeding parastomal varices with N-butyl-2-cyanoacrylate”. Gastrointestinal Endoscopy 6 (2004): 1007‑1008.
13. A C FantinBleeding anorectal varices: successful treatment with transjugular intrahepatic portosystemic shunting (TIPS) (2025).
14. Firoozi B., et al. “Endoscopic band ligation of bleeding rectal varices”. Digestive Diseases and Sciences 7 (2002): 1502‑1505.
15. Levine J., et al. “Endoscopic ligation of bleeding rectal varices”. Gastrointestinal Endoscopy 2 (1993): 188‑90.
16. Wang M., et al. “Endoscopic sclerotherapy for bleeding rectal varices: a case report”. The American Journal of Gastroenterology  10 (1985): 779‑780.
17. Yamanaka T., et al. “Endoscopic sclerotherapy (ethanolamine oleate injection) for acute rectal varices bleeding in a patient with liver cirrhosis”. Hepatogastroenterology46 (2002): 941‑943.
18. Sousa M., et al. “Histoacryl injection for treatment of varices in the ascending colon”. Endoscopy 1 (2016): E285.
19. S M., et al. “Endoscopic glue injection therapy with N-butyl-2-cyanoacrylate for bleeding from isolated large rectal varices”. Endoscopy S 01 (2024).
20. Tao Z., et al. “Successful Hemostasis for a Rectal Ejection Hemorrhage After Ligation Using N-Butyl-2-Cyanoacrylate Injection”. The American Journal of Gastroenterology 3 (2020): 319.
21. Soehendra N., et al. “Endoscopic obliteration of large esophagogastric varices with bucrylate”. Endoscopy 1 (1986): 25‑26.
22. Chen WC., et al. “An endoscopic injection with N-butyl-2-cyanoacrylate used for colonic variceal bleeding: a case report and review of the literature”. The American Journal of Gastroenterology  2 (2000): 540‑542.
23. Soo Hyung Ryu., et al. “Endoscopic injection sclerotherapy with N-butyl-2-cyanoacrylate in a patient with massive rectal variceal bleeding: a case report”. Gastrointestinal Endoscopy (2025).
24. Tang Y., et al. “Endoscopic ultrasound-guided coiling and glue injection for bleeding from isolated rectal varices”. Endoscopy S 01 (2025): E73‑74.

Citation

Citation: Aicha Darif. “Cyanoacrylate Glue Injection for Bleeding Rectal Varices: An Uncommon but Effective Strategy".Acta Scientific Gastrointestinal Disorders 8.9 (2025): 23-26.

Copyright

Copyright: © 2025 Aicha Darif. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.