Fatal Haematuria in a Patient with an Orthotopic Neobladder and Chronic Liver Failure

Oderda, Marco; Mondino, P.; Lucca, Ilaria; Fiorito, Chiara; Gillo, Arianna; Zitella, Andrea; Greco, Alessandro; Tizzani, A; Gontero, Paolo

doi:10.1159/000241686

Cited by 8 publications

(4 citation statements)

References 19 publications

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“…Ectopic variceal bleeding is rare, and is an uncommon cause of gastrointestinal hemorrhage in portal hypertensive patients; it is difficult to diagnose and treat [2]. ICSVs are a rarely reported type of ectopic varices in patients who develop PH after urinary diversion [14][15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Successful hybrid surgery for ileal conduit stomal varices following oxaliplatin-based chemotherapy in a patient with advanced colorectal cancer

et al. 2020

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Background Ectopic variceal bleeding is a rare but life-threatening complication of portal hypertension (PH). Oxaliplatin-based chemotherapy for colorectal cancer (CRC) is associated with sinusoidal obstruction syndrome of the liver, which can lead to PH. Case presentation Here, we report a successful hybrid surgery that included intraoperative obliteration of ileal conduit stomal varices (ICSVs) for a 66-year-old woman with CRC and liver metastasis that had been treated multimodally during the previous 4 years, including 17 courses of oxaliplatin-based chemotherapy. She was admitted to our hospital for massive hemorrhage from an ileal conduct stoma. Image findings showed ICSVs as a part of portosystemic shunt, which were afferently supplied from the superior mesenteric vein (SMV) and drained by the numerous cutaneous veins connected to the left femoral vein. Obliteration of the stomal varices by interventional radiologic techniques alone was inappropriate because of difficulties of cannulating the efferent cutaneous veins. We, therefore, performed hybrid surgery for the ICSV, which included cannulation into the SMV branch and antegrade obliteration of the varices with a 5% solution of ethanolamine oleate with iopamidol under blocking the SMV flow, using a vascular clip and ligation. Hemorrhage in her ileal conduit stoma disappeared completely. Conclusion Customized treatment of ectopic varices should be based on their precise vascular anatomy; hybrid surgery with intraoperative angiography is an alternative treatment for ectopic varices such as ICSV.

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Section: Discussionmentioning

confidence: 99%

Successful hybrid surgery for ileal conduit stomal varices following oxaliplatin-based chemotherapy in a patient with advanced colorectal cancer

et al. 2020

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“…Ileal conduit stomal varices rarely develop in patients with portal hypertension after urinary diversion. Reports on ileal conduit stomal varices are limited and most are case reports [2] , [3] , [4] . Hemorrhage is a serious problem of ileal conduit stomal varices, and can be life-threatening [1] , [2] .…”

Section: Discussionmentioning

confidence: 99%

Successful embolization of ileal conduit stomal varices with N-butyl cyanoacrylate via a recanalized paraumbilical vein

Onishi¹,

Kimura²,

Kanagaki³

et al. 2018

Radiology Case Reports

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A 77-year-old woman with liver cirrhosis was admitted to our hospital for marked hemorrhage in her ileal conduit stoma. She had a history of cystectomy and urinary diversion for bladder carcinoma 2 years ago. Contrast-enhanced CT demonstrated varices in the ileal conduit stoma. We accessed the varices via a recanalized paraumbilical vein to avoid pain from the transhepatic approach, and selectively embolized the varices with N-butyl cyanoacrylate (NBCA). We consider antegrade embolization of ileal conduit stomal varices with NBCA to be effective and feasible. Access via a paraumbilical vein is a useful alternative to the transhepatic approach.

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“…Case reports have also suggested that abdominal surgery in and of itself may play a role in the development of ectopic varices-including vesical varices-in patients with portal hypertension [6][7][8]. In addition, development of ectopic varices in intestinal conduits has been observed in portal hypertensive patients with urologic pathology that had required the creation of a neobladder [9][10][11].…”

Section: Discussionmentioning

confidence: 99%

Vesical varices: an unusual presentation of portal hypertension

2015

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Fatal Haematuria in a Patient with an Orthotopic Neobladder and Chronic Liver Failure

Cited by 8 publications

References 19 publications

Successful hybrid surgery for ileal conduit stomal varices following oxaliplatin-based chemotherapy in a patient with advanced colorectal cancer

Successful hybrid surgery for ileal conduit stomal varices following oxaliplatin-based chemotherapy in a patient with advanced colorectal cancer

Successful embolization of ileal conduit stomal varices with N-butyl cyanoacrylate via a recanalized paraumbilical vein

Vesical varices: an unusual presentation of portal hypertension

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