Intractable Parastomal Bleeding in a Portal Hypertensive Patient Managed by Direct Sclerotherapy: A Case Report Publisher



Yazdi NA¹ ; Aletaha N² ; Mehrabinejad MM^{1, 3} ; Dehnavi AZ^{1, 3} ; Yazdi HR¹
Source: Gastroenterology and Hepatology from Bed to Bench Published:2020

Abstract

Patients with a stoma have 5% chance of developing parastomal varices, which tend to repetitive massive and life-threatening hemorrhages. Treatment of choice in parastomal varices have not been established, while Transjugular Intrahepatic Portosystemic Shunt (TIPS) has been revealed as the most successful measure. We report a hemodynamically unstable patient with a history of Ulcerative Colitis (UC) and Primary Sclerosing Cholangitis (PSC) with colostomy, because of colon cancer who presented with massive parastomal bleeding. Non-operative treatments and TIPS failed to control the symptoms. Color Doppler ultrasound showed a hepato-fugal flow. The direct antegrade technique, using Sodium Tetradecyl Sulfate (STS 1%) and glue-Lipiodol, was applied under ultrasonography guidance, and complete stoppage of bleeding was achieved. No immediate or late complication or follow-up recurrence were noted after 8 months. In case of hepatofugal flow, direct percutaneous mesenteric parastomal venous access and sclerotherapy is a rapid and relatively safe procedure for parastomal variceal bleeding. © 2020 RIGLD, Research Institute for Gastroenterology and Liver Diseases.