Peristomal varices after proctocolectomy in patients with primary sclerosing cholangitis

Wiesner, Russell H.; LaRusso, Nicholas F.; Dozois, Roger R.; Beaver, Sandra J.

doi:10.1016/0016-5085(86)90926-1

Cited by 144 publications

(79 citation statements)

References 10 publications

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“…However, in one study, ␤-blocker therapy did not appear to be effective in the management of peristomal varices. 9 We recommend the use of ␤-blocking agents in the prevention of rebleeding or when patients cannot undergo a surgical shunt. This is usually when portal venous thrombosis is so extensive that a suitable vein (8 mm or more in diameter) cannot be found for anastomosis with a systemic vein.…”

Section: Management Of Bleeding Ectopic Varicesmentioning

confidence: 99%

“…The most common scenario for stomal varices is in patients with ileostomies after proctocolectomy for inflammatory bowel disease with associated primary sclerosing cholangitis. 9 Stomal varices are recognized by the purplish hue around the stoma. The patient is usually aware of the bleed early in its clinical course and may be taught how to control the hemorrhage with pressure.…”

Section: Management Of Bleeding Ectopic Varicesmentioning

confidence: 99%

“…The best recognized of these ectopic varices is stomal varices formed at ileostomy sites in patients with primary sclerosing cholangitis who have undergone colectomy with creation of an ileostomy for inflammatory bowel disease, usually ulcerative colitis. 9 On rare occasions varices may be present in the colon in the absence of portal hypertension caused by anomalies of portal venous outflow, such as congenital anomalies of normal portosystemic anastomoses, 10 abnormal vessel strucAbbreviation: TIPS, transjugular intrahepatic portosystemic shunt. From the…”

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confidence: 99%

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Management of ectopic varices

1998

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The term ''ectopic varices'' is sometimes reserved for abnormally dilated veins associated with gastrointestinal mucosa and, therefore, with the potential for gastrointestinal hemorrhage. However, the term has also been used loosely to describe portosystemic collateral veins in the abdominal wall and retroperitoneum. The distinction between ''ectopic varices'' and collaterals that are commonly found on the abdominal wall and retroperitoneum of patients with portal hypertension is one of semantics. Thus, ectopic varices may be best defined as large portosystemic venous collaterals occurring anywhere in the abdomen except in the cardioesophageal region.Ectopic varices are an unusual cause of gastrointestinal hemorrhage, but account for up to 5% of all variceal bleeding. 1 The clinician caring for patients with gastrointestinal bleeding must be aware of this entity, because diagnosis and management of ectopic varices differ from that of esophagogastric varices. Furthermore, the prognosis from bleeding ectopic varices may be poor, with one study quoting 40% mortality at initial bleed from duodenal varices. 2 The literature on this subject consists mainly of small series and case reports with no randomized trials of therapeutic modalities. However, a review of the literature does provide sufficient information from which rational management decisions can be made. PREVALENCEEctopic varices account for between 1% and 5% of all variceal bleeding. 1,3 Ectopic varices are a relatively common finding at endoscopy in patients with portal hypertension. The prevalence seems to be related to the cause of the portal hypertension and the technique used to show the varices. In patients with intrahepatic portal hypertension, duodenal varices are seen in 40% of patients undergoing angiography, 3 whereas anorectal varices have been reported in between 10% and 40% of cirrhotic patients undergoing colonoscopy. 4,5 It is important to differentiate anal varices from hemorrhoids: Anal varices collapse with digital pressure, whereas hemorrhoids do not. 4 In patients with portal hypertension caused by obstruction of the portal or splenic veins, duodenal varices are more prevalent than in patients with intrahepatic portal hypertension. The prevalence is higher if angiography is used to show varices. In fact, most patients with portal or splenic vein thrombosis are likely to have duodenal varices shown on angiography. 6,7 The majority of patients with duodenal varices visualized on endoscopy have extrahepatic portal hypertension. In contrast to duodenal varices, it appears that most cases of varices in other portions of the small intestine and colonic varices are seen in patients with intrahepatic portal hypertension who have previously undergone abdominal surgery. 6 In the west, because the prevalence of extrahepatic portal hypertension is low, most bleeding from ectopic varices is usually associated with intrahepatic portal hypertension. 6,8 Stomal varices are a particularly common cause of ectopic varices and occur in patients with intrah...

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Section: Management Of Bleeding Ectopic Varicesmentioning

confidence: 99%

Section: Management Of Bleeding Ectopic Varicesmentioning

confidence: 99%

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confidence: 99%

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Management of ectopic varices

1998

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“…Local treatment to control bleeding usually fails, and these patients frequently experience rebleeding episodes during follow-up. 72 A portosystemic shunt can prevent rebleeding from peristomal varices, but because these patients often suffer from end-stage liver disease, liver transplantation seems to be the most appropriate treatment. Ileostomy should be avoided in those PSC patients requiring colectomy, especially with more advanced liver disease, and a surgical procedure less susceptible to variceal formation such as ileoanal, ileorectal, or ileal pouch-anal anastomosis is preferred.…”

Section: Portal Hypertensionmentioning

confidence: 99%

Primary sclerosing cholangitis

1999

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“…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]. Het behoeft weinig toelichting dat na het reviseren van het stoma binnen afzienbare tijd nieuwe varices zullen ontstaan; de druk in het portale systeem blijft immers onveranderd hoog.…”

Section: Beschouwingunclassified

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

et al. 2017

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Samenvatting Parastomale varices kunnen leiden tot levensbedreigende en moeilijk te behandelen stomabloedingen. Dit artikel betreft een casus van een fatale stomabloeding bij een patiënte met parastomale varices op basis van levercirrose. Tevens worden verschillende therapeutische mogelijkheden besproken en eerdere casus uit de literatuur aangehaald.Trefwoorden Bricker · parastomale bloeding · parastomale varices · urinedeviatie Case-report. Haemorrhage from peristomal varicesAbstract Peristomal varices can give rise to life-threatening haemorrhage that can be difficult to treat. This paper describes the case of a fatal stomal haemorrhage in a patient with peristomal varicous veins due to hepatic chirrosis. A range of therapeutical options and previous cases from the literature are being discussed.

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Peristomal varices after proctocolectomy in patients with primary sclerosing cholangitis

Cited by 144 publications

References 10 publications

Management of ectopic varices

Management of ectopic varices

Primary sclerosing cholangitis

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

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