Bleeding stomal varices in portal hypertension

Area of Science:

• Interventional Radiology
• Hepatology
• Gastroenterology

Background:

• Stomal variceal bleeding is a rare but potentially fatal complication in patients with liver cirrhosis and a history of colostomy.
• Existing treatment options for stomal variceal bleeding are limited and lack standardized protocols.
• The high mortality rate underscores the need for effective and innovative management strategies.

Observation:

• A 50-year-old male with liver cirrhosis and post-colostomy colon cancer presented with active stomal bleeding and clots.
• The patient exhibited signs of significant gastrointestinal bleeding originating from the stoma.

Findings:

• Successful treatment was achieved using a transjugular intrahepatic portosystemic shunt (TIPS) procedure.
• Concomitant embolization of stomal varices was performed through the TIPS shunt using N-butyl cyanoacrylate mixed with ethiodol.
• This combined approach represents a novel therapeutic strategy for managing stomal variceal bleeding.

Implications:

• This case highlights a potentially life-saving, combined interventional radiology technique for a rare and dangerous condition.
• The successful outcome suggests that TIPS placement with embolization may be a viable treatment option where standard therapies fail.
• Further research and case studies are warranted to establish the efficacy and safety of this combined approach in managing stomal variceal bleeding.