LAUSR

A 59-year-old man with cirrhosis and portal hypertension presented with melena and was found to have bleeding gastric varices on upper endoscopy. 1.2 mL of Histoacryl glue (B Braun Medical, Bethlehem, PA) was injected into gastric varices at the cardia (Figure 1). Haemostasis was achieved and he was discharged. In the subsequent months, he had recurrent episodes of fever partially responsive to antibiotic treatment. During an admission six months after the initial endoscopic treatment, blood cultures yielded Klebisella spp. He was investigated with computed tomography (CT) which revealed multiple multiloculated rim-enhancing lesions in the left adrenal gland and upper pole of the left kidney, with perifocal fat stranding, in keeping with abscesses. The glue cast was seen along the cardia and lesser curvature of the stomach, extending through serpiginous vasculature into the left adrenal gland and adrenal vein. The gastric varices were obliterated. The patient was treated by CT-guided aspiration of the left adrenal abscess (Figure 2) by the interventional radiologist and systemic antibiotics. Culture of the aspirated pus confirmed Klebsiella spp. He improved clinically and follow-up CT six months later showed complete resolution of the abscesses. The patient remained well.