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Bleeding from peristomal varices: Perspectives on prevention and treatment

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

Peristomal variceal bleeding is a serious complication in patients with chronic liver disease undergoing colon surgery with a stoma. Our aim was to examine the morbidity of bleeding for peristomal, perianastomotic, and esophageal varices in a group of patients with chronic liver disease who underwent colectomy at the Mayo Clinic between 1970 and 1988. Morbidity was evaluated in terms of the number of major bleeding episodes and the number of units of blood transfused. The treatment of bleeding was also evaluated. One hundred seventeen patients (74 males and 43 females) aged 11–78 years were studied. Sixty-two patients (53 percent) had a permanent stoma, while 55 patients (47 percent) had a colonic resection and anastomosis. Sixty-seven patients (62 percent) had chronic ulcerative colitis and primary sclerosing cholangitis. In the stoma group, bleeding appeared from stomal and/or esophageal varices in 19 patients (31 percent), while, in the non-stoma group, bleeding exclusively from the esophageal varices occurred in eight patients (15 percent). Perianastomotic variceal bleeding was never observed. The 5-year cumulative probabilities of one major bleed occurring from gastrointestinal varices appeared to be similar between the two groups. Patients who bled from peristomal varices with or without esophageal bleeding (n=17) rebled more frequently (6.5±5.5 vs.3±1.6; P <0.05) and were transfused more often (14.9±12.3 vs.7.5±4.1; P <0.05) than patients who bled exclusively from esophageal varices (n=10). No difference was found in the incidence of recurrent bleeding and the number of units of blood transfused between patients who bled exclusively from peristomal varices (n=10) and those who bled from both peristomal and esophageal varices (n =7). Medical and local measures were more effective in controlling esophageal bleeding than in controlling peristomal bleeding. Therefore, patients with chronic liver disease who must undergo colectomy should have a distal anastomosis rather than a terminal stoma.

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Author information

Authors and Affiliations

  1. Section of Colon and Rectal Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota

    Claudio Fucini M.D., Bruce G. Wolff M.D. & Roger R. Dozois M.D.

Authors
  1. Claudio Fucini M.D.
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  2. Bruce G. Wolff M.D.
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  3. Roger R. Dozois M.D.
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Additional information

Read in part at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, April 27 to May 4, 1990.

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Fucini, C., Wolff, B.G. & Dozois, R.R. Bleeding from peristomal varices: Perspectives on prevention and treatment. Dis Colon Rectum 34, 1073–1078 (1991). https://doi.org/10.1007/BF02050064

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  • DOI: https://doi.org/10.1007/BF02050064

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