Hepatic to Pulmonary Embolism of Absorbable Gelatin Hemostatic Sponge in Two Egyptian Fruit Bats (Rousettus aegyptiacus): A Complication of Its Use in Hepatic Biopsy Procedures
Thirty-four adult Egyptian fruit bats (Rousettus aegyptiacus) were enrolled in a study on iron regulation during which liver biopsies were collected at two timepoints. Absorbable gelatin hemostatic sponge (GS)a was inserted at the biopsy sites as necessary for local hemostasis. Sixteen of the bats have subsequently died or been euthanized and examined histologically; intravascular GS was identified histologically in the lungs of two bats. The identification of GS was based on the presence of amphophilic amorphous flaky material that stained strongly positive with periodic acid-Schiff technique. The first case, which died one year after biopsy, had hepatic abscessation and necrosis with intralesional budding yeast and GS at the initial biopsy site. Pulmonary lesions included vascular thrombosis with intralesional yeast and/or GS, neutrophilic bronchopneumonia, and hemorrhage. The second case, which died three years after biopsy, also showed hepatic abscessation with intralesional bacteria, pulmonary vascular thrombosis with intralesional GS and septic pneumonia. GS is used frequently in veterinary medicine; no complications were described in a recent retrospective study of its use in 50 domestic small animal cases.1 In contrast, foreign body reactions, nidus of infection/abscessation, anaphylaxis/hypersensitivity, granuloma formation, and local tissue compression have been described in human patients.1 The finding of GS embolization in these two bats highlights a need for reconsideration of potential adverse effects related to its use.
a. Spongostan Dental, Ethicon, Somerville, NJ, USA
1. Charlesworth TM, Agthe P, Moores A, Anderson DM. The use of haemostatic gelatin sponges in veterinary surgery. J Small Anim Pract. 2012;53:51–56.