Long-term outcome of percutaneous transhepatic venous embolization for ectopic peristomal variceal bleeding: A case...

Bleeding from ectopic varices secondary to portal hypertension represents a significant therapeutic challenge due to the absence of standardized management protocols.

This case report details the long-term management and follow-up of a rare and challenging case of recurrent hematuria caused by bleeding from ectopic peristomal varices secondary to portal hypertension in a patient with an ileal neobladder.

Hematuria secondary to ectopic peristomal varices of an ileal neobladder associated with portal hypertension.

The patient underwent 2 sessions of percutaneous transhepatic obliteration (PTO) (in April 2018 and February 2022) for active variceal bleeding.

After the initial PTO, hematuria resolved immediately, and a follow-up computed tomography at 3 months confirmed complete occlusion of the variceal complex. Recurrent hematuria occurred at 16 and 20 months post-procedure; imaging demonstrated recanalization attributable to persistent portal hypertension rather than technical failure of the initial embolization. A second PTO in February 2022 again achieved complete control of bleeding. No further hematuria occurred after the second PTO, for a recurrence-free interval of approximately 3 years and 10 months (February 2022 to December 2025), approximately 7 years and 8 months after the initial procedure. The most recent computed tomography revealed only minimal, nonprogressive residual peristomal varices without active bleeding.

PTO may provide immediate hemostasis and durable symptom control in selected patients with ectopic peristomal variceal bleeding; however, because embolization does not treat the underlying portal hypertension, recurrence remains possible, necessitating structured long-term surveillance and readiness for repeat intervention or portal pressure-reducing therapy. This case, with 7-year follow-up, illustrates the feasibility and long-term outcomes of repeated PTO for ectopic variceal bleeding at a complex anatomical site.