Massive Cecal Variceal Hemorrhage Treated with Transjugular Intrahepatic Portosystemic Shunt with Right Colic Vein and Ileocolic Vein Embolization

Mehta, Tej I; Clarey, Dillon; Plorde, Joshua; Patel, Jay; Yim, Douglas

doi:10.7759/cureus.4392

Cited by 4 publications

(4 citation statements)

References 10 publications

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“…In fact, angioembolization can lead to an increase in portal pressure. TIPS and liver transplant are considered defnitive therapy in ectopic cecal varices secondary to cirrhotic portal hypertension [1,[4][5][6][7].…”

Section: Discussionmentioning

confidence: 99%

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Ectopic Cecal Varices as a Cause of Lower Gastrointestinal Bleeding

Qatomah

Almushir

Aljohani

2023

Case Reports in Gastrointestinal Medicine

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Ectopic varices account for 1%–5% of all variceal bleeding episodes in patients with portal hypertension. They can be found at any part of gastrointestinal tract including the small intestines, colon, or rectum. We report a case of a 59-year-old man who presented with bleeding per rectum 2 days after a routine colonoscopy, in which 2 lesions were biopsied. Gastroscopy was negative for bleeding, and he was not stable enough to undergo colonoscopy. CT angiography showed a large portosystemic shunt with multiple collaterals in the right lower quadrant. These findings were clues for a diagnosis of ectopic cecal varices.

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Section: Discussionmentioning

confidence: 99%

“…In the few cases that report refractory bleeding ectopic cecal varices, total and partial colectomy had been reported [4][5][6]. Te use of vasoactive substances like octreotide and β-blockers has been tried but not studied.…”

Section: Discussionmentioning

confidence: 99%

Ectopic Cecal Varices as a Cause of Lower Gastrointestinal Bleeding

Qatomah

Almushir

Aljohani

2023

Case Reports in Gastrointestinal Medicine

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“…Another study examined the efficacy of TIPS in ectopic variceal bleeding via a multicenter retrospective examination, and while they only had one patient with a cecal bleed, the patient did experience a positive outcome of no future bleeding [ 6 ]. Another case report described successful stabilization in a patient with hemorrhagic ectopic varices with coil embolization after TIPS procedure [ 7 ]. It is important to note that percutaneous embolization carries with it risks that need to be weighed with the benefits in each individual case.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Transhepatic Embolization of Ectopic Varices in a Patient With Portal Hypertension Presenting With Hemorrhagic Shock

Ohs¹,

Jones²,

Sharma³

et al. 2021

Cureus

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Varices secondary to portal hypertension in the setting of liver cirrhosis typically occur in the gastroesophageal region. Management guidelines for bleeding gastroesophageal varices are well established in the literature. Ectopic varices that occur outside of this typical location are an uncommon complication of portal hypertension. Rarely, these varices can result in life-threatening hemorrhage. Management guidelines of ectopic variceal bleeds are not yet standardized as cases are rare and treatment approach in the literature has historically varied. We present an interesting case of a 37-year-old patient with alcoholic liver disease and cirrhosis who developed spontaneous hemorrhage and shock from bleeding ectopic varices. This report exemplifies how coil embolization via a percutaneous transhepatic approach can be used to manage ectopic variceal bleeds in the setting of hemorrhagic shock.

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“…Although there are established guidelines for the management of oesophageal and gastric variceal bleeding, this is currently lacking for colonic varices. Various treatment methods have been reported, including the use of beta-blockers, transjugular intrahepatic portosystemic shunt (TIPS), and subtotal colectomy (El-Masry and Hu 2010; Francois et al 2007;Haddad and Lacey 2014;Klein et al 2003;Mehta et al 2019;Mikat 1971;Shaper et al 1996;Krishna et al 2010;Langemets and Ilves 2017). However, management is typically dependent on local expertise, the underlying cause and the site of the varices.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Background: Ectopic varices are uncommon and typically due to underlying liver cirrhosis. They can be located in the duodenum, small intestines, colon or rectum, and may result in massive haemorrhage. While established guidelines exist for the management of oesophageal and gastric variceal bleeding, this is currently lacking for colonic varices. Beta-blockers, transjugular intrahepatic portosystemic shunt insertion and subtotal colectomy have been reported as management methods. However, there are only two other cases that have reported successfully treating colonic varices using balloon-occluded retrograde transvenous obliteration (BRTO), an endovascular procedure typically performed for gastric varices. Case presentation: A 55-year-old man with background of alcoholic liver cirrhosis presented with per-rectal bleeding due to caecal varices. Grade 2-3 oesophageal varices were identified on oesophago-gastroduodenoscopy, and computed tomography showed multiple right para-colic portosystemic collaterals around the hepatic flexure and ascending colon. Colonoscopy confirmed fresh blood in the colon up to the caecum, with a submucosal varix deemed the most likely source of haemorrhage. As transjugular intrahepatic portosystemic shunt insertion was potentially technically difficult, due to left portal vein thrombosis and a small right portal venous system, he underwent BRTO, which successfully embolised and thrombosed the colonic varices without complications. Conclusions: Whilst further studies are required to conclude its effectiveness and efficacy, BRTO may be considered a viable solution in managing ectopic, colonic, variceal haemorrhage especially when traditional techniques are unsuccessful or contraindicated.

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Massive Cecal Variceal Hemorrhage Treated with Transjugular Intrahepatic Portosystemic Shunt with Right Colic Vein and Ileocolic Vein Embolization

Cited by 4 publications

References 10 publications

Ectopic Cecal Varices as a Cause of Lower Gastrointestinal Bleeding

Ectopic Cecal Varices as a Cause of Lower Gastrointestinal Bleeding

Percutaneous Transhepatic Embolization of Ectopic Varices in a Patient With Portal Hypertension Presenting With Hemorrhagic Shock

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

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