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[Recurrent peri-stomal varix hemorrhage after diversion using the Bricker's technique]
R Soret1, E Goullet, J L Bonnal
1Service d'Urologie, CHU Lille-Roubaix, France.
Summary
Peristomal varices, a rare complication in patients with urinary diversions and portal hypertension, can cause severe bleeding. Transjugular intrahepatic portosystemic shunt (TIPS) effectively reduced portal hypertension and bleeding in a patient with cirrhosis and an ileal bladder.
Area of Science:
- Gastroenterology and Hepatology
- Urology
- Interventional Radiology
Background:
- Portal hypertension can lead to complications like peristomal varices in patients with gastrointestinal or urinary diversions.
- Radical surgery for invasive bladder tumors in patients with hepatic cirrhosis presents unique postoperative challenges.
- Hemorrhage from peristomal varices in ileal bladders is a rare but serious complication.
Observation:
- A patient with Child B cirrhosis underwent radical cystoprostatectomy and Bricker diversion for invasive bladder cancer.
- Two months post-surgery, the patient experienced recurrent, severe bleeding from peristomal varices.
- Local hemostasis measures were unsuccessful in controlling the variceal bleeding.
Findings:
- Transjugular intrahepatic portosystemic shunt (TIPS) placement was performed to manage the bleeding.
- TIPS effectively reduced portal hypertension and the severity of peristomal variceal hemorrhage.
- This intervention provided a successful alternative to surgical shunts, which carry high risks in debilitated patients.
Implications:
- TIPS is a viable and effective treatment option for refractory peristomal variceal bleeding in patients with portal hypertension and urinary diversions.
- Managing complex cases involving both oncologic surgery and liver disease requires multidisciplinary approaches.
- Reducing portosystemic pressure gradient is crucial when local bleeding control is not feasible.