Case Series Regarding Parastomal Variceal Bleeding: Presentation and Management

Area of Science:

• Gastroenterology
• Hepatology
• Interventional Radiology

Background:

• Parastomal variceal bleeding (PVB) is a rare but serious complication in patients with ostomies and portal hypertension.
• Effective management strategies for PVB are not well-established, posing significant clinical challenges.

Observation:

• This case series details the management of five patients with PVB, alongside a systematic literature review of 163 patients.
• Interventions included transjugular intrahepatic portosystemic shunt (TIPS), sclerotherapy, and coil embolization.
• One patient expired due to hemorrhagic shock after embolization and sclerotherapy; another, deemed high-risk, experienced spontaneous bleed resolution but later died of sepsis.

Findings:

• Transjugular intrahepatic portosystemic shunt (TIPS) combined with embolization and sclerotherapy was effective in preventing rebleeding in one patient for over 441 days.
• Embolization and sclerotherapy alone successfully prevented rebleeding in another patient for 290 days.
• Transjugular intrahepatic portosystemic shunt (TIPS) alone resulted in successful discharge without rebleeding in one patient, though long-term follow-up was lost.

Implications:

• Transjugular intrahepatic portosystemic shunt (TIPS), often in combination with other therapies, appears to be a viable option for managing parastomal variceal bleeding.
• While some patients may benefit from less invasive procedures or even conservative management if the bleed resolves spontaneously, careful risk assessment is crucial.
• Further research and standardized guidelines are needed to optimize the treatment of this infrequent but potentially fatal complication.