Abstract
Stomal varices can occur in patients with stoma in the presence of portal hypertension. Suture ligation, sclerotherapy, angiographic embolization, stoma revision, beta blockade, portosystemic shunt, and liver transplantation have been described as therapeutic options for bleeding stomal varices. We report the case of a 21-year-old patient with primary sclerosing cholangitis and colectomy with ileostomy for ulcerative colitis, where stomal variceal bleeding was successfully treated by direct percutaneous embolization. We consider percutaneous embolization to be an effective way of treating acute stomal bleeding in decompensated patients while awaiting decisions regarding shunt procedures or liver transplantation.
This is a preview of subscription content, log in via an institution to check access.
References
Vangeli M, Patch D, Terreni N et al (2004) Bleeding ectopic varices—treatment with transjugular intrahepatic porto-systemic shunt (TIPSS) and embolisation. J Hepatol 41:560–566
Weisner RH, LaRusso NF, Dozois RR (1986) Peristomal varices after proctocolectomy in patients with primary sclerosing cholangitis. Gastroenterology 90:316–322
Norton ID, Andrews JC, Kamath PS (1998) Management of ectopic varices. Hepatology 28:1154–1158
Kinkhabwala M, Mousavi A, Iyer S et al (1977) Bleeding ileal varicosity demonstrated by transhepatic portography. Am J Roentgenol 129:514–516
Resnick RH, Ishihara A, Chalmers TC et al (1968) A controlled trial of colon bypass in chronic hepatic encephalopathy. Gastroenterology 54:1057–1069
Fucini C, Wolff BG, Dozois RR (1991) Bleeding from peristomal varices: perspectives on prevention and treatment. Dis Colon Rectum 34:1073–1078
Conte JV, Arcomano TA, Naficy MA et al (1990) Treatment of bleeding stomal varices: report of à case and review of the literature. Dis Colon Rectum 33:308–314
Roberts PL, Martin FM, Schoetz DJ Jr et al (1990) Bleeding stomal varices. The role of local treatment. Dis Colon Rectum 33:547–549
Spier BJ, Fayyad AA, Lucey MR et al (2008) Bleeding stomal varices: case series and systematic review of the literature. Clin Gastroenterol Hepatol 6:346–352
Adson MA, Fulton RE (1997) The ileal stoma and portal hypertension: an uncommon site of variceal bleeding. Arch Surg 112:501–504
Macedo TA, Andrews JC, Kamath PS (2005) Ectopic varices in the gastrointestinal tract: short- and long-term outcomes of percutaneous therapy. Cardiovasc Intervent Radiol 28:178–184
Thouveny F, Aubé C, Konaté A et al (2008) Direct percutaneous approach for endoluminal glue embolisation of stomal varices. J Vasc Interv Radiol 9:774–777
Naidu SG, Castle EP, Kriegshauser JS et al (2010) Direct percutaneous embolization of bleeding stomal varices. Cardiovasc Intervent Radiol 33:201–204
Kochar N, Tripathi D, McAvoy NC et al (2008) Bleeding ectopic varices in cirrhosis: the role of transjugular intrahepatic portosystemic stent shunts. Aliment Pharmacol Ther 28:294–303
Malinchoc M, Kamath PS, Gordon FD et al (2000) A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology 31:864–871
Hassoun Z, Deschênes M, Lafortune M et al (2001) Relationship between pre-TIPS liver perfusion by the portal vein and the incidence of post-TIPS chronic hepatic encephalopathy. Am J Gastroenterol 96:1205–1209
Rosado B, Kamath PS (2003) Transjugular intrahepatic portosystemic shunts: an update. Liver Transpl 9:207–217
Acknowledgments
The authors state that there are no conflicts of interest or financial disclosures to declare.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Arulraj, R., Mangat, K.S. & Tripathi, D. Embolization of Bleeding Stomal Varices by Direct Percutaneous Approach. Cardiovasc Intervent Radiol 34 (Suppl 2), 210–213 (2011). https://doi.org/10.1007/s00270-010-9886-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-010-9886-y