Management of refractory rectal variceal bleed using computed tomography.

Area of Science:

• Interventional Radiology
• Gastroenterology
• Hepatology

Background:

• Rectal varices are portosystemic collaterals stemming from portal hypertension.
• Bleeding from rectal varices, though less common than esophageal varices, poses a life-threatening risk.
• Management of refractory rectal variceal bleeding presents a significant clinical challenge.

Purpose of the Study:

• To describe a novel, minimally invasive percutaneous technique for managing refractory rectal variceal bleeding.
• To evaluate the efficacy of CT-guided percutaneous N-butyl cyanoacrylate (NBCA) glue injection in a complex case.

Main Methods:

• A 28-year-old male with hematemesis and hematochezia presented with actively bleeding rectal varices.
• Diagnostic workup included sigmoidoscopy and CT abdominal angiogram, confirming rectal varices.
• CT-guided percutaneous NBCA glue injection of rectal varices was performed after failure of endoscopic sclerotherapy.

Main Results:

• The CT-guided percutaneous NBCA glue injection achieved immediate and complete cessation of rectal bleeding.
• The procedure was successfully performed in a complex clinical scenario where conventional treatments had failed.

Conclusions:

• CT-guided percutaneous NBCA glue injection is a viable and effective minimally invasive option for refractory rectal variceal bleeding.
• This technique offers a promising alternative for patients with treatment-resistant rectal varices and portal hypertension.