Bleeding from peristomal varices: a complication of portal hypertension

Abstract

SummaryPeristomal varices are a recognised complication of stomas in the presence of portal hypertension. There has been a progression of treatment options described in the literature, including the transjugular intrahepatic portosystemic shunt (TIPS). The use of TIPS, a percutaneous procedure allowing connection between the portal and systemic circulations within the liver, is a well-recognised method of treating the complications of portal hypertension. This report presents a case of peristomal varices successfully treated with TIPS and subsequently reviews the literature relating to its management.

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

“…There are multiple strategies to treat a variceal ostomy bleed including local control (manual pressure or pressure dressings, suture ligation, sclerotherapy, intravascular coil, or glue embolization), portal vein decompression with TIPS, and liver transplant. 1-9 In the majority of cases, local therapy is used as first-line treatment as demonstrated in our patient who was successfully treated with sclerotherapy. We would like to highlight the possibility of ultrasound-guided percutaneous sclerotherapy of ostial varices with sodium tetradecyl sulfate though care is needed to prevent stomal damage.…”

“…Literature review supports use of direct pressure, suture ligation, intravascular coil, glue embolization, and sclerotherapy in the acute variceal bleed setting. [1][2][3][4][5][6][7][8][9] To our knowledge, there are no reports of direct ultrasound-guided percutaneous injection of sodium tetradecyl sulfate to treat bleeding abdominal wall stomal varices and this case highlights the safety and feasibility of such a technique, particularly when the patient has significant contraindications for TIPS.…”

“…1 Mortality from stomal variceal bleeding, though 10-fold lower than esophageal variceal bleeding, is still approximately 3% to 4% per occurrence. 2 Conservative local therapies can have a rebleeding rate as high as 70%, commonly requiring blood transfusions and hospitalization when they occur. 3 Due to their rarity, an optimal interventional approach to acute stomal variceal bleed has not been established.…”

Stomal varices: An unusual cause of bleeding in patients with portal hypertension

“…Nowadays, the most optimal treatment has not been found yet due to the fact that there are very few cases with this pathology and most of the studies are reviews or series of cases with very few patients. Among invasive treatment options, percutaneous sclerotherapy, liver transplant, TIPS and embolization combined or not with TIPS can be performed (3,4,7,8). Among these possibilities, in several studies, TIPS proves to be effective in patients who do not respond to conservative treatment (3,8,9), as the procedure treats the underlying problem of a high portal venous pressure (8,10).…”

Case-report. Bloedverlies uit een Brickerse lis op basis van parastomale varices

“…Een meer invasief alternatief voor TIPS is het chirurgisch aanleggen van een portosystemische shunt, die echter gepaard gaat met een hoge morbiditeit en mortaliteit (5-15 %) [11]. Zelfs levertransplantaties zijn beschreven; deze geven binnen twee weken significante afname van bloedverlies [12].…”