A case of ascending colon variceal bleeding treated with venous coil embolization

Abstract

A 38-year-old female with a history of alcoholic liver cirrhosis visited our hospital with a massive hematochezia. An esophagogastroduodenoscopy did not demonstrate any bleeding source, and a colonoscopy showed a massive hemorrhage in the ascending colon but without an obvious focus. The source of the bleeding could not be found with a mesenteric artery angiography. We performed an enhanced abdominal computed tomography, which revealed a distal ascending colonic varix, and assumed that the varix was the source of the bleeding. We performed a venous coil embolization and histoacryl injection to obliterate the colon varix. The intervention appeared to be successful because the vital signs and hemoglobin laboratory data remained stable and because the hematochezia was no longer observed. We report here on a rare case of colonic variceal bleeding that was treated with venous coil embolization.

Lower GI Bleeding: An Update on Incidences and Causes

“…The incidence of colonic varices is 0.07% but it may account for 1 to 8% of LGIB in patients with cirrhosis. 44 Bleeding from varices carries a poor prognosis often due to the underlying cause of portal hypertension. There have been reports of familial varices which presented with LGIB in young patients.…”

Balloon-occluded retrograde transvenous obliteration of colonic varices: a case report

“…Management of ectopic varices was most common by observation (41.1%) and endoscopic methods of injection sclerotherapy and variceal ligation (29.2%), with 7.7% requiring surgery (Watanabe et al 2010). To the authors' knowledge, there are three reported cases of attempted BRTO for colonic varices, of which two were successful (Anan et al 2006;Matsumoto et al 2018;Ko et al 2013). Anan et al (Anan et al 2006) described the first successful BRTO of descending colonic varices, thereby obliterating the portosystemic shunt, for the treatment of hepatic encephalopathy.…”

“…Matsumoto et al (Matsumoto et al 2018) reported the second successful case, obliterating ascending colonic varices through the right testicular vein, preventing variceal rupture. Ko et al (Ko et al 2013) reported a failed BRTO attempt in a 38-year-old female with variceal bleeding of the ascending colon, which was eventually treated by venous coil embolisation and histoacryl injection.…”

Right Sided Colonic Varices: 2 Cases and Review of the Literature

“…Portal decompression is appropriate in patients with portal hypertension, and has included: beta blocker [18,23] somatostatin infusion/ octreotide [23,27], vascular stenting (TIPS and portal vein stenting) [12,17,19] and heparine [8]. Local control therapy included: catheter embolization [16,19], cyanoacrylate infusion [19,22], argon plasma coagulation [21], and ligation [11,20]. In case of splenic vein occlusion all reported cased advocated a splenectomy [13][14][15].…”

“…hypertension of the portal venous system in the absence of liver cirrhosis: (partial)occlusion by external or internal compression of: mesenteric vein [8,9], the portal vein [10][11][12] splenic vein [13][14][15] or the complete splenomesenterico-portal axis. Associated conditions are: venous thrombosis (clotting disorder, chronic or acute pancreatitis, pancreatic cancer), and external compression (pancreatic cancer, pseudocysts, retroperitoneal fibrosis) Hepatic: mainly by cirrhosis [16][17][18][19][20][21][22], and schistosomiasis, sardoidosis, sinusoidal obstruction syndrome Post-hepatic: Budd-chiari, Inferior cava caval obstruction [23], right side heart failure Idiopathic portal hypertension [24].…”