Managing Recurrent Rectal Variceal Bleeding Secondary to Portal Hypertension With Liquid Embolics.

Area of Science:

• Gastroenterology and Hepatology
• Interventional Radiology

Background:

• Rectal variceal bleeding is an uncommon but serious complication of portal hypertension, often associated with chronic liver disease.
• Management of rectal varices is challenging, with limited established treatment guidelines.
• Portal vein thrombosis can further complicate the clinical picture and treatment approach.

Observation:

• A patient with portal vein thrombosis presented with chronic, recurrent rectal bleeding due to rectal varices, necessitating blood transfusions.
• The patient underwent a trans-splenic embolization procedure using liquid agents (sclerotherapy and glue) without balloon occlusion.
• Hemostasis at the access site was successfully achieved using a vascular plug.

Findings:

• Trans-splenic embolization with liquid agents provided a successful and minimally invasive alternative for managing rectal varices.
• This technique effectively achieved cessation of bleeding in a challenging clinical scenario.
• The use of a vascular plug ensured secure hemostasis of the access tract.

Implications:

• This approach offers a viable treatment option for rectal varices when colonoscopic methods are insufficient or unsuccessful.
• It highlights the potential of interventional radiology techniques in managing rare gastrointestinal bleeding sources.
• Further research into standardized protocols for trans-splenic embolization of rectal varices is warranted.