[Colostomy-induced varices in portal hypertension]

Varices of the colostomy are a rare complication of colostomy performed in patients with portal hypertension. This work is based on 14 cases. The colic stomy is the terminal operation in surgery for cancer in twelve cases, and a bypass stomy in two cases. Portal hypertension is due to cirrhosis in 10 cases and to metastases to the liver in 4 cases. All 14 colostomy varices were expressed by bleeding. In 7 cases, oesophageal varices were detected with fiberendoscopy. Only one of these patients had an upper digestive hemorrhage. Colostomy hemorrhages are the revealing complication and the main sign of the disease. The emergent treatment of bleeding of the colostomy must combine several methods, most often consecutively: local compression, ligation, sclerotherapy. Once bleeding is controlled, the radical treatment must be primarily medical (hygienic and dietary habits, beta-adrenergic blocking agents), but complementary surgery may prove to be necessary, most often to redo the colostomy with additional deconnection. The prognosis mainly depends on the function of the liver, the deterioration of which is accelerated by the successive hemorrhagic accidents. Hepatorenal failure is the main cause of death.