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

Onishi, Yasuyuki; Kimura, Hiroyuki; Kanagaki, Mitsunori; Oka, Shojiro; Fukumoto, Genki; Otani, Tomoaki; Matsubara, Naoko; Kawabata, Kazuna; Yasufuku, Tomihiko; Yamada, Yuji

doi:10.1016/j.radcr.2018.07.024

Cited by 10 publications

(11 citation statements)

References 9 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%

“…According to previous reports, nine cases of ICSV associated with portal hypertension after urinary diversion have been reported. In eight of all cases, endovascular treatment was performed and most of the endovascular treatment was TIPS [ 15 , 17 , 25 – 31 ]. TIPS—which uses a percutaneous catheter to create a short circuit between the portal and hepatic veins in the liver—has been widely used in Western countries for reducing the pressure of portal vein as a treatment for PH, but seems to be unsatisfactory for ectopic varices, with a reported 21–37% rebleeding rate [ 8 , 32 ], arguably because ectopic varices are formed as a part of portosystemic shunt, so the pressure of portal vein is mostly lower in patients with ectopic varices than in those with esophageal varices [ 10 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

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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%

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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“…A recanalized umbilical vein has been reported to occur in more than 20% of patients with portal hypertension [8] . Previous case reports have demonstrated the usefulness of the transparaumbilical venous approach for embolization of gastroesophageal and ectopic varices due to cirrhosis [3] , [4] , [5] , [6] , [7] . The benefits of the transparaumbilical venous approach include reduced invasiveness and enhanced accessibility to target vessels, compared with other approach routes (eg, percutaneous transhepatic, transjugular, transfemoral, and mesenteric venous routes).…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Approaches for embolization of a portosystemic shunt include percutaneous transhepatic, transjugular, transfemoral, transparaumbilical, and mesenteric venous routes. A percutaneous approach to the portal venous system via the paraumbilical vein has been reported [3] , [4] , [5] , [6] , [7] ; however, it remains unfamiliar to many clinicians, compared with other routes. We describe a patient who exhibited chronic hepatic encephalopathy due to a paraumbilical shunt; embolization was successfully performed by means of a percutaneous transparaumbilical venous approach.…”

Section: Introductionmentioning

confidence: 99%

Embolization of a paraumbilical shunt by the transparaumbilical venous approach and one-sheath inverse method: A case report

Kamada

Ota

Seiji

et al. 2020

Radiology Case Reports

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We describe treatment of a 53-year-old man with chronic hepatic encephalopathy. Contrast-enhanced computed tomography demonstrated a recanalized paraumbilical vein as a portosystemic shunt connecting the left branch of the portal vein and bilateral iliac veins. Percutaneous embolization was performed. The paraumbilical vein was punctured under ultrasonographic guidance; a 7-Fr sheath was inserted in the cranial direction. The hepatic side of the shunt was embolized with a vascular plug. The sheath direction was inverted to the caudal side; the pelvic side of the shunt was then embolized with another vascular plug. This report demonstrates that the percutaneous transparaumbilical venous approach is useful and safe for portosystemic shunt intervention. Moreover, the one-sheath inverse method was useful for embolization of upstream and downstream sides of the puncture site.

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“…Conservative treatments, including local compression, bleeding vessel ligation, or sclerotherapy, may be considered but have a high recurrence rate of bleeding. In cases of continuous bleeding persisting even after initial treatment, endovascular embolization 1,2,9 or transjugular intrahepatic portocaval shunt 3,9,10 can be applied.…”

Section: Kjuomentioning

confidence: 99%

Recurrent Bleeding From Ileal Conduit Stomal Varices in a Patient With Portal Hypertension

Chung

Lee

et al. 2021

Korean J Urol Oncol

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Bleeding from ileal conduit stomal varices is uncommon and rarely reported. 1 It can particularly develop in portal hypertension patients, and fatal massive bleeding from stomal varices can occur, 2 making early detection crucial. This bleeding mainly occurs in enterostomal varices at the mucocutaneous borderline level. 3 Management is challenging and varies from local treatment to shunting, embolization, and surgery. We present the case of a 65-year-old man with recurrent fatal bleeding from his ileal conduit stomal varices successfully treated with ligation of the engorged venous varices using hemostatic agents.

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

Cited by 10 publications

References 9 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

Embolization of a paraumbilical shunt by the transparaumbilical venous approach and one-sheath inverse method: A case report

Recurrent Bleeding From Ileal Conduit Stomal Varices in a Patient With Portal Hypertension

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