A Novel Approach for Management of Bleeding Stomal Varices: A Case Report of Ultrasound-Guided Percutaneous Sclerotherapy

Uhlenhopp, Dustin; Olson, Kristin; Sunkara, Tagore

doi:10.1177/2324709620904569

Cited by 2 publications

(2 citation statements)

References 9 publications

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“…The most common story may be the occurrence in patients with ileostomies after proctocolectomy for inflammatory bowel disease with associated primary sclerosing cholangitis. As with the other varices, it is related to the collateral development, branch of superior mesenteric vein (76), or that of IMV (77), in post-colectomy patients with portal hypertension. It is considered as a treatment resistive condition because the threshold portal pressure gradient leading to bleeding may be lower than for EV or gastric varices (78).…”

Section: Stomal Varicesmentioning

confidence: 99%

Collaterals in portal hypertension: anatomy and clinical relevance

Maruyama¹,

Shiina²

2021

Quant Imaging Med Surg

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Portal hypertension is a key pathophysiology of chronic liver diseases typified with cirrhosis or noncirrhotic portal hypertension. The development of collateral vessels is a characteristic feature of impaired portal hemodynamics. The paraumbilical vein (PUV), left gastric vein (LGV), posterior gastric vein (PGV), short gastric vein (SGV), splenorenal shunt (SRS), and inferior mesenteric vein (IMV) are major collaterals, and there are some rare collaterals. The degree and hemodynamics of collateral may affect the portal venous circulation and may compensate for the balance between inflow and outflow volume of the liver. Additionally, the development of collateral shows a relation with the liver function reserve and clinical manifestations such as esophageal varices (EV), gastric varices, rectal varices and the other ectopic varices, hepatic encephalopathy, and prognosis. Furthermore, there may be an interrelationship in the development between different collaterals, showing additional influences on the clinical presentations. Thus, the assessment of collaterals may enhance the understanding of the underlying pathophysiology of the condition of patients with portal hypertension. This review article concluded that each collateral has a specific function depending on the anatomy and hemodynamics and is linked with the relative clinical presentation in patients with portal hypertension. Imaging modalities may be essential for the detection, grading and evaluation of the role of collaterals and may help to understand the pathophysiology of the patient condition. Further investigation in a large-scale study would elucidate the basic and clinical significance of collaterals in patients with portal hypertension and may provide information on how to manage them to improve the prognosis as well as quality of life.

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Section: Stomal Varicesmentioning

confidence: 99%

Collaterals in portal hypertension: anatomy and clinical relevance

Maruyama¹,

Shiina²

2021

Quant Imaging Med Surg

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“…The probability of rebleeding can be reduced by 78.5% [7]. Some other new interventional methods for the treatment of varicose bleeding, including retrograde venous embolization with balloon closure and ultrasound-guided percutaneous intravenous sclerotherapy, can have partial e cacy [8,9]. For patients with advanced liver cirrhosis and liver failure, the most fundamental treatment strategy is liver transplantation.…”

Section: Discussionmentioning

confidence: 99%

Ligating the varicose vein trunk for colostomy variceal hemorrhage: a case report

Sun¹,

Tan²,

Chen³

et al. 2023

Preprint

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Background: Among the complications related to colostomy, variceal hemorrhage caused by cirrhosis is a rare case. The occurrence of peristome variceal hemorrhage should be rapid and effective treatment, otherwise it will result in hemorrhagic shock, repeated stoma bleeding, systemic organs deterioration and other adverse events. Case presentation: In this case of liver cirrhosis, Stoma varices and repeated bleeding due to decompensated cirrhosis was performed by local compression and suture therapy but failed with rebleeding. Being combined with abdominal enhanced CT images，Stoma varices are derived from the branch of inferior mesenteric vein, whose above trunk is located and highly ligated and vein balls are stripped. Meanwhile, the Stoma below abdominal wall varicose veins is sutured by intracutaneous way, which could achieve satisfactory hemostasis in intra-operation. Abdominal enhanced CT images prompted that peristome varicose veins are disappeared. The skin around the stoma is flat and the mucosa is ruddy when changing the bag in post-operation. Conclusion: The report that our team reduced the risk of peristomal variceal bleeding by blocking the main variceal vein through a small incision under local anesthesia may open up another treatment strategy for such patients.

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A Novel Approach for Management of Bleeding Stomal Varices: A Case Report of Ultrasound-Guided Percutaneous Sclerotherapy

Cited by 2 publications

References 9 publications

Collaterals in portal hypertension: anatomy and clinical relevance

Collaterals in portal hypertension: anatomy and clinical relevance

Ligating the varicose vein trunk for colostomy variceal hemorrhage: a case report

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