\documentclass[10pt]{article}

\usepackage{fullpage}
\usepackage{setspace}
\usepackage{parskip}
\usepackage{titlesec}
\usepackage[section]{placeins}
\usepackage{xcolor}
\usepackage{breakcites}
\usepackage{lineno}
\usepackage{hyphenat}





\PassOptionsToPackage{hyphens}{url}
\usepackage[colorlinks = true,
            linkcolor = blue,
            urlcolor  = blue,
            citecolor = blue,
            anchorcolor = blue]{hyperref}
\usepackage{etoolbox}
\makeatletter
\patchcmd\@combinedblfloats{\box\@outputbox}{\unvbox\@outputbox}{}{%
  \errmessage{\noexpand\@combinedblfloats could not be patched}%
}%
\makeatother


\usepackage{natbib}




\renewenvironment{abstract}
  {{\bfseries\noindent{\abstractname}\par\nobreak}\footnotesize}
  {\bigskip}

\titlespacing{\section}{0pt}{*3}{*1}
\titlespacing{\subsection}{0pt}{*2}{*0.5}
\titlespacing{\subsubsection}{0pt}{*1.5}{0pt}


\usepackage{authblk}


\usepackage{graphicx}
\usepackage[space]{grffile}
\usepackage{latexsym}
\usepackage{textcomp}
\usepackage{longtable}
\usepackage{tabulary}
\usepackage{booktabs,array,multirow}
\usepackage{amsfonts,amsmath,amssymb}
\providecommand\citet{\cite}
\providecommand\citep{\cite}
\providecommand\citealt{\cite}
% You can conditionalize code for latexml or normal latex using this.
\newif\iflatexml\latexmlfalse
\providecommand{\tightlist}{\setlength{\itemsep}{0pt}\setlength{\parskip}{0pt}}%

\AtBeginDocument{\DeclareGraphicsExtensions{.pdf,.PDF,.eps,.EPS,.png,.PNG,.tif,.TIF,.jpg,.JPG,.jpeg,.JPEG}}

\usepackage[utf8]{inputenc}
\usepackage[ngerman,english]{babel}



\usepackage{float}








\begin{document}

\title{Unexpected bowel obstruction after the treatment of gastric varices}



\author[1]{Ryo Yamauchi}%
\author[2]{Kazuhide Takata}%
\author[2]{Fumihito Hirai}%
\affil[1]{Fukuoka University}%
\affil[2]{Fukuoka University Faculty of Medicine}%


\vspace{-1em}



  
  \date{May 26, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
\maketitle
\endgroup





\selectlanguage{english}
\begin{abstract}
As a complication of GV treatment with Histoacryl\selectlanguage{ngerman}®, boweel obstruction
is not common. However, when the patients with a history of abdominal
surgery complain of an abdominal pain after the GV treatment, we should
also consider bowel obstruction.%
\end{abstract}\selectlanguage{ngerman}%



\sloppy


\textbf{Unexpected bowel obstruction after the treatment of gastric
varices}

*Ryo Yamauchi, Kazuhide Takata, Fumihito Hirai

Department of Gastroenterology and Medicine, Fukuoka University Faculty
of Medicine, Fukuoka, Japan

\textbf{*Corresponding author:}

Ryo Yamauchi

Department of Gastroenterology and Medicine, Fukuoka University Faculty
of Medicine

7-45-1 Nanakuma, Jonan, Fukuoka 814-0180, Japan

E-mail: r\_christinue2017@yahoo.co.jp

\textbf{Key Clinical Meeage}

As a complication of GV treatment with Histoacryl\selectlanguage{ngerman}®, ileus is not common.
However, when the patients with a history of abdominal surgery complain
of an abdominal pain after the GV treatment, we should also consider
ileus.

\textbf{Question}

A 66-year-old man with decompensated alcoholic cirrhosis presented with
abdominal pain. He had a history of an appendectomy 23 years previously.
He underwent endoscopic injection sclerotherapy (EIS) using
N-butyl-2-cyanoacrylate (Histoacryl®) for gastric varices (GV) 1 month
previously (Figure 1). Physical examination was normal. Abdominal X-ray
revealed small intestinal gas with niveau and a 3-cm, high-density
structure in the pelvic cavity (Figure 2). What is the diagnosis and
cause?

\textbf{Answer}

The structure was found in the GV after EIS treatment. We believe that
the small intestine obstruction resulted from a part of the polymer
falling out of the GV after EIS treatment. Bowel obstruction was treated
conservatively and, the polymer was excreted naturally from the
intestine. GV, detected using endoscopy, are found in 20\% of patients
with cirrhosis portal hypertension. Treatment for GV using Histoacryl®
was first reported in 1986\textsuperscript{1}, and it became the
first-line management option of GV due to its rapid hardening quality in
the blood\textsuperscript{2}. After sclerotherapy, solidified
Histoacryl® may be frequently extruded as a polymer into the
lumen\textsuperscript{2}. There are no previous reports of bowel
obstruction caused by the polymer after EIS using Histoacryl®; however,
it is possible that the extruded polymer caused the obstruction.

\textbf{Acknowledgements}

We would like to thank Editage (www.editage.jp) for English language
editing.

\textbf{Conflict of interest statement}

None of the authors have conflicts of interest associated with this
manuscript. No external funding source was utilized for this paper.

\textbf{Author's contributions}

Ryo Yamauchi designed the study, collected data, and drafted the
manuscript.

Kazuhide Takata designed the study and collected data.

Fumihito Hirai approved the article.

All authors critically revised the manuscript, approved the final
version to be published, and agree to be accountable for all aspects of
the work.

\textbf{References}

1. Soehendra, N., Grimm, H., Nam, V.C., and Berger, B. 1987.
N-butyl-2cyanoacrylate: a supplement to endoscopic sclerotherapy.
Endoscopy 19: 221-224.

2. Wang, Y.M., Cheng, L.F., Li, N., Wu, K., Zhai, J.S., and Wang, Y.W.
2009. Study of glue extrusion after endoscopic N-butyl-2-cyanoacrylate
injection on gastric variceal bleeding. World J Gastroenterol 15:
4945-4951.

\textbf{Figure Legends}

\textbf{Figure 1.}

Endoscopic findings of endoscopic injection sclerotherapy treatment with
Histoacryl® for gastric varices.

\textbf{Figure 2.}

Abdominal X-ray showing small intestinal gas with niveau and a 3-cm,
high-density structure in the pelvic cavity.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/20200607-Figure-1/20200607-Figure-1}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/20200607-Figure-2/20200607-Figure-2}

\end{center}
\end{figure}

\selectlanguage{english}
\FloatBarrier
\end{document}

