A Case of Recurrent Refractory Stomal Variceal Bleeding Associated with Oxaliplatin-Induced Portal Hypertension

Stomal variceal bleeding is a rare but potentially life-threatening complication in patients with gastrointestinal stomas complicated by portal hypertension. Although oxaliplatin-based chemotherapy is widely used for colorectal cancer, it is known to cause sinusoidal obstruction syndrome (SOS), which may result in non-cirrhotic portal hypertension. However, stomal variceal bleeding secondary to oxaliplatin-induced portal hypertension has rarely been reported.

A 67-year-old man underwent curative surgery for rectal cancer, followed by 12 courses of oxaliplatin-based chemotherapy for pelvic recurrence. During chemotherapy, progressive anal pain led to the creation of a colostomy. After resumption of chemotherapy, recurrent and refractory stomal bleeding developed following an additional 5 courses. Despite conservative management, including local hemostatic measures and blood transfusions, the bleeding persisted. CT and laboratory examinations revealed splenomegaly, dilatation of the portal and mesenteric veins, and thrombocytopenia without evidence of liver cirrhosis. Based on these findings, portal hypertension caused by oxaliplatin-induced SOS was considered the most likely etiology of the stomal varices. Percutaneous transhepatic obliteration (PTO) was therefore performed and successfully achieved complete hemostasis without recurrence.

Clinicians should be aware that oxaliplatin-induced portal hypertension can cause stomal variceal bleeding even in the absence of liver cirrhosis. Careful long-term monitoring for portal hypertensive complications is warranted in patients receiving prolonged oxaliplatin-based chemotherapy. Percutaneous transhepatic variceal obliteration represents a safe and effective treatment option for refractory stomal variceal bleeding.