J Korean Med Sci.  2007 Jun;22(3):583-587. 10.3346/jkms.2007.22.3.583.

A Case of Successful Treatment of Stomal Variceal Bleeding with Transjugular Intrahepatic Portosystemic Shunt and Coil Embolization

• Han SG
• Han KJ
• Cho HG
• Gham CW
• Choi CH
• Hwang SY
• Song SY

• KMID: 1778378
• DOI: http://doi.org/10.3346/jkms.2007.22.3.583

Abstract

Variceal bleeding from enterostomy site is an unusual complication of portal hypertension. The bleeding, however, is often recurrent and may be fatal. The hemorrhage can be managed with local measures in most patients, but when these fail, surgical interventions or portosystemic shunt may be required. Herein, we report a case in which recurrent bleeding from stomal varices, developed after a colectomy for rectal cancer, was successfully treated by placement of transjugular intrahepatic portosystemic shunt (TIPS) with coil embolization. Although several treatment options are available for this entity, we consider that TIPS with coil embolization offers minimally invasive and definitive treatment.

Keyword

Varices; Stoma; Bleeding; Transjugular Intrahepatic Portosystemic Shunt (TIPS); Embolization

MeSH Terms

Colectomy/adverse effects
Contrast Media/pharmacology
Embolization, Therapeutic/*methods
Esophageal and Gastric Varices/surgery
Gastrointestinal Hemorrhage/*therapy
Humans
Male
Middle Aged
*Portasystemic Shunt, Transjugular Intrahepatic
Rectal Neoplasms/surgery
Tomography, X-Ray Computed/methods
Treatment Outcome

Figure

• 

  Fig. 1 Esophageal varices are noted in esophagogastroduodenoscopy before transjugular intrahepatic portosystemic shunt (TIPS). (A) After TIPS, the esophageal varices are disappeared in esophagogastroduodenoscopy (B).

• 

  Fig. 2 Axial scans of portal phase computed tomography (A, B) show gastroesophageal varices and findings of liver cirrhosis with a large amount of ascites. There are dilated venous structures along the wall of the stoma (arrowhead). The maximum intensity projection image (C) and direct volume rendering image (D) confirm unusual portosystemic collateral through the mucocutaneous junction of the stoma. Dilated draining veins of abdominal wall are noted (arrows).

• 

  Fig. 3 On direct portogram, (A) there are prominent gastroesophageal varices. Retrograde flow of contrast dye through the stoma into the collateral veins of abdominal wall on selective inferior mesenteric venogram (B). The transjugular intrahepatic portosystemic shunt (TIPS) tract is dilated with a balloon catheter, and a metallic stent is placed in the tract (C). Selective inferior mesenteric vein venography obtained after coil embolization and creation of TIPS show collapsed lumen and disappearance of retrograded flow (D).

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