Successful Treatment of Bleeding Rectal Varices with Balloon-Occluded Retrograde Transvenous Obliteration in a Patient with a History of Sigmoidectomy

Abstract

Rectal varices most commonly develop in patients with portal hypertension due to liver cirrhosis. Although rectal varices rarely cause bleeding, their rupture can lead to life-threatening massive hemorrhages. Balloonoccluded retrograde obliteration (BRTO) is feasible in cases of varices involving a single or a few drainage vessels. Although rectal varices usually have numerous drainage vessels, the present case involved a single drainage vessel. The unusual presentation of the current case was considered to have been caused by a previous surgery for sigmoid colon carcinoma. BRTO was successfully performed through the left internal iliac vein, achieving complete hemostasis of the rectal varices.

Successful treatment of rectal varices with antegrade transvenous sclerotherapy via the splenorenal shunt from the transjugular approach

“…Currently, there is no consensus or standardization on treatment of the rectal varices, although management algorithms have been proposed [8 , 12] . Endoscopic variceal ligation and endoscopic injection sclerotherapy are usually the first choice due to low invasiveness [13] , although in our case multiple endoscopic treatments proved unsuccessful in controlling the varices. Among IR procedures, TIPS is an effective method that was introduced into rectal variceal treatment by Katz et al.…”

“…Balloon-occluded retrograde transvenous obliteration (BRTO), introduced in 1996 by Kanagawa et al [17] , is considered a gold standard in treating gastric varices. There are reports in the literature that demonstrate successful management of rectal varices with this technique [13] , but it is not applicable in most cases. This is because rectal varices tend to develop multiple outflow vessels [13] (as in our patient, with multiple outflow veins draining into both internal iliac veins), and the retrograde transvenous approach is of limited efficacy.…”

“…There are reports in the literature that demonstrate successful management of rectal varices with this technique [13] , but it is not applicable in most cases. This is because rectal varices tend to develop multiple outflow vessels [13] (as in our patient, with multiple outflow veins draining into both internal iliac veins), and the retrograde transvenous approach is of limited efficacy. Furthermore, studies following treatment of gastric varices showed that BRTO does not decrease portal pressure, leading to development or exacerbation of esophageal varices [5 , 8] .…”