Bleeding Stomal Varices and Vascular Interventional Radiology Management: A Case Report

Stomal varices are a rare but life-threatening complication of portal hypertension. While multiple approaches are used to treat these varices, clinicians often face significant diagnostic and therapeutic challenges. A 55-year-old woman with a history of cirrhosis and low rectal cancer presented with massive stomal variceal bleeding requiring transfusion support. Emergency bleeding control was achieved using percutaneous NBCA-lipiodol embolization of the dominant feeding vein. Approximately ten months after the initial procedure, the patient experienced another episode of stomal bleeding caused by small collateral varicose veins, requiring blood transfusion, which was effectively treated with ultrasound-guided targeted local sclerotherapy. No further stomal bleeding recurrence was noted during one year of follow-up after sclerotherapy. This case highlights the feasibility of two different minimally invasive and accessible techniques, glue embolization and sclerotherapy, in managing bleeding stomal varices in the same patient. The favorable long-term results support the potential role of these approaches as reliable alternatives for high-risk surgical patients awaiting liver transplantation or when TIPS is not available.