TIPS is Effective for Bleeding of Stomal Varices: Report of a Case

Sonoda, Hiromichi; Morishita, Hiroyuki; Shioaki, Yasuhiro; Kimura, Hiroyuki; Shimizu, Tomoharu; Tani, Tohru

doi:10.4030/jjcs.40.144

Cited by 1 publication

(3 citation statements)

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“…Stomal varices occur at the border between the intestine and abdominal wall at the stoma-mucosal junction as a blood channel of the portal-systemic shunt under conditions of portal hypertension [ 5 ]. A total of 27–31% of patients with portal hypertension due to chronic liver disease reportedly develop varicose veins when colostomy is performed [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…We searched for reports from PubMed (1950 to January 2022) using the keywords “stomal varices”, “stomal variceal”, or “stoma varix”. Among them, we extracted reports of stomal varices related to oxaliplatin-based chemotherapy in colorectal cancer cases and found six reports, including our case [ 5 , 35 , 44 , 50 , 51 ] (Table 2 ). There were five cases of liver metastasis, and five cases were diagnosed as SOS.…”

Section: Discussionmentioning

confidence: 99%

“…CAPOX therapy is a standard treatment recommended as adjuvant chemotherapy and primary treatment for recurrence of colorectal cancer, but sinusoidal obstruction syndrome (SOS) has been reported as an important side effect of oxaliplatin [ 1 , 2 ]. SOS reportedly causes fibrosis and stenosis of sinusoids, which eventually leads to portal hypertension [ 3 , 4 ], and portal hypertension increases inferior mesenteric vein (IMV) pressure, resulting in the appearance of stoma varicose veins [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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A case of percutaneous transhepatic stomal varices embolization and partial splenic artery embolization for rectal cancer after CAPOX/BEV chemotherapy: the summary of the stomal varices related to oxaliplatin administration

Mizukami

Shonaka²,

Tani³

et al. 2022

Clin J Gastroenterol

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Capecitabine and oxaliplatin (CAPOX) plus bevacizumab (BEV) therapy (CAPOX/BEV) is a standard treatment recommended as the first-line treatment for colorectal cancer recurrence. Recently, sinusoidal obstruction syndrome (SOS) and resulting portal hypertension have been reported as important side effects of oxaliplatin. We herein report a rectal cancer patient who underwent percutaneous transhepatic stoma variceal embolization (PTO) and partial splenic artery embolization (PSE) for stomal variceal bleeding and splenomegaly due to portal hypertension caused by SOS after CAPOX therapy. A 43-year-old man who underwent robot-assisted laparoscopic abdominoperineal resection for advanced lower rectal cancer was started on CAPOX/BEV therapy for early recurrence 1 month after surgery. In the sixth course, splenomegaly rapidly worsened, stomal varices appeared, and the stoma began bleeding. At 5 months after the appearance of stomal varices, the splenomegaly worsened, the frequency of stomal bleeding increased, and PTO was performed. Five months later, PSE was performed for splenomegaly and thrombocytopenia. At 5 months since the PSE, the stoma bleeding has not recurred, and the thrombocytopenia has been corrected. The patient has been able to continue chemotherapy. We suggest that staged treatment by PTO and PSE be considered an important treatment option for stomal varices and splenomegaly associated with SOS.

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Section: Discussionmentioning

confidence: 99%