Pathology of Shock Accompanying Endoscopic Embolization of Esophageal Varices Using Thrombin

Abstract

We reported earlier that transient hypotention, shock and DIC occur following injection of about 20,000 units of thrombin into esophageal varices for endoscopic embolization. The hypotention and shock seem to be associated with the formation of microthrombi because their onset coincided with decreases in fibrinogen and platelets at a very early stage of DIC. In the present study, after thrombin injection, AaDO₂ increased according to blood gas analysis, but no microthrombi could be found in the lung by surface counting using ¹²⁵I-fibrinogen, and the ratio of thromboxane B₂/6-keto PG F_1α increased. Thus, hypotention following thrombin injection may be induced by vasoactive substances disturbing pulmonary circulation and might be relieved by rapid inactivation of these substances.