Korean J Gastroenterol.  2014 Nov;64(5):290-293. 10.4166/kjg.2014.64.5.290.

Recurrent and Troublesome Variceal Bleeding from Parastomal Caput Medusae

• Strauss C
• Sivakkolunthu M
• Ayantunde

• KMID: 2164432
• DOI: http://doi.org/10.4166/kjg.2014.64.5.290

Abstract

Variceal bleeding is common in chronic liver disease and is a frequent cause of acute upper gastrointestinal bleeding. The most common site of varices is the lower oesophagus but they may occur at any location where there are portosystemic anastomoses and collateral vascular formation. Location of ectopic varices at the site of enterocutaneous stomas is rare. We report on three cases of recurrent and severe bleeding from parastomal varices, requiring hospital admission. The patients had chronic liver disease but of different aetiological factors. Variceal formation results from portal hypertension due to chronic liver disease. There are various treatment options for parastomal variceal bleeding, including local, medical, and surgical interventions. Management of parastomal variceal bleeding presents a recurring and difficult problem. Bleeding may be considerable and sometimes life threatening. This diagnosis must be considered in patients with chronic liver disease presenting with stomal bleeding, even where the variceal formation may not be readily visible.

Keyword

Stoma; Variceal bleeding; Liver cirrhosis; Propranolol; Portal hypertension

MeSH Terms

Aged, 80 and over
Chronic Disease
Female
*Gastrointestinal Hemorrhage
Humans
Liver Diseases/complications/*pathology
Male
Middle Aged
Recurrence
Severity of Illness Index
Tomography, X-Ray Computed
Varicose Veins/complications/*diagnosis

Figure

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  Fig. 1. Parastomal varices in patient 1. Abnormal radial vascular formation in surrounding skin with extensive circumferential purplish discolouration (raspberry appearance) and ulceration at the mucocutaneous junction of the ileostomy.

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  Fig. 2. CT scan showing a cirrhotic liver due to primary sclerosing cholangitis in patient 2. Irregular and nodular cirrhotic liver with portal hypertension.

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  Fig. 3. CT scan showing parastomal variceal vessels in patient 2. Presence of prominent and tortuous abnormal parastomal vasculature due to parastomal varices (collateral vessels) indicated with an arrow.

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  Fig. 4. Parastomal varices in patient 3. Purplish circumferential colouration (raspberry appearance) around the left iliac fossa stoma with three areas of ulcerations at the mucocutaneous junction and bleeding point.

Reference

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