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Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
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Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension

Published on: November 15, 2024

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Portal Hypertensive Colopathy with Pelvic Varices presenting as Severe Lower GI Bleed treated with TIPSS

S F Murphy1, M Durand1, J P McMorrow1

  • 1Department of Radiology, St James's Hospital, Dublin 8.

Irish Medical Journal
|June 29, 2018
PubMed

Insights

Portal hypertensive colopathy, a complication of alcoholic liver cirrhosis, caused severe gastrointestinal bleeding in a patient. A Transjugular Intrahepatic Portosystemic Shunt (TIPSS) procedure successfully resolved the bleeding and associated varix.

Area of Science:

  • Gastroenterology
  • Hepatology
  • Interventional Radiology

Background:

  • Alcoholic liver cirrhosis can lead to portal hypertension, increasing the risk of gastrointestinal complications.
  • Portal hypertensive colopathy is a recognized cause of lower gastrointestinal bleeding in patients with liver disease.

Observation:

  • A 71-year-old female with a history of alcohol abuse presented with severe lower GI bleeding, abdominal pain, and anemia.
  • Imaging revealed colonic thickening, an atrophic liver, an enlarged superior mesenteric vein (SMV), and a pelvic varix, consistent with portal hypertensive colopathy.

Findings:

  • Conservative management failed, necessitating intervention.
  • A Transjugular Intrahepatic Portosystemic Shunt (TIPSS) procedure was performed, leading to immediate cessation of lower GI bleeding.
  • Follow-up imaging demonstrated decompression of the SMV and resolution of the pelvic varix.

Implications:

  • TIPSS is an effective treatment for refractory portal hypertensive colopathy and associated varices.
  • This case highlights the importance of considering portal hypertensive colopathy in patients with alcoholic liver cirrhosis and lower GI bleeding.
  • Successful management can lead to significant clinical improvement and patient discharge.

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