Peristomal variceal bleeding treated by coil embolization using a percutaneous transhepatic approach

Area of Science:

• Hepatology
• Interventional Radiology
• Gastroenterology

Background:

• Portal hypertension can lead to rare but severe complications like peristomal variceal bleeding.
• Colorectal carcinoma with liver metastasis can present with complex venous thrombosis, complicating treatment options.

Observation:

• A 68-year-old female patient with a history of colostomy for colorectal carcinoma experienced massive hemorrhage from her colostomy conduit.
• The patient had medial and right hepatic veins thrombosis secondary to liver metastasis invasion, posing significant challenges for standard interventions.

Findings:

• An emergency percutaneous transhepatic coil embolization was successfully performed to control the life-threatening bleeding.
• This interventional radiology technique provided a definitive solution for the peristomal variceal bleeding.

Implications:

• Percutaneous transhepatic coil embolization is a safe and effective treatment for peristomal variceal bleeding in high-risk patients.
• This approach is particularly valuable when transjugular intrahepatic portosystemic shunt is contraindicated due to complex venous anatomy or patient factors.