CardioVascular and Interventional Radiology

, Volume 33, Issue 1, pp 201–204 | Cite as

Direct Percutaneous Embolization of Bleeding Stomal Varices

  • Sailen G. Naidu
  • Erik P. Castle
  • J. Scott Kriegshauser
  • Eric A. Huettl
Case Report


Stomal variceal bleeding can develop in patients with underlying cirrhosis and portal hypertension. Most patients are best treated with transjugular intrahepatic portosystemic shunt (TIPS) creation because this addresses the underlying problem of portal hypertension. However, some patients are not good candidates for TIPS creation because they have end-stage liver disease or encephalopathy. We describe such a patient who presented with recurrent bleeding stomal varices, which was successfully treated with percutaneous coil embolization. The patient had bleeding-free survival for 1 month before death from unrelated causes.


Stomal varices Portal hypertension Percutaneous therapy TIPS 


  1. 1.
    Scaletscky R, Wright JK Jr, Shaw J, Smith JA Jr (1994) Ileal conduit venous varices from portal hypertension as a cause of recurrent, massive hemorrhage: case report and review of the literature. J Urol 151:417–419PubMedGoogle Scholar
  2. 2.
    Resnick RH, Ishihara A, Chalmers TC, Schimmel EM (1968) A controlled trial of colon bypass in chronic hepatic encephalopathy. Gastroenterology 54:1057–1069PubMedGoogle Scholar
  3. 3.
    Fucini C, Wolff BG, Dozois RR (1991) Bleeding from peristomal varices: perspectives on prevention and treatment. Dis Colon Rectum 34:1073–1078CrossRefPubMedGoogle Scholar
  4. 4.
    Ryu RK, Nemcek AA Jr, Chrisman HB et al (2000) Treatment of stomal variceal hemorrhage with TIPS: case report and review of the literature. Cardiovasc Intervent Radiol 23:301–303CrossRefPubMedGoogle Scholar
  5. 5.
    Morris CS, Najarian KE (2000) Transjugular intrahepatic portosystemic shunt for bleeding stomal varices associated with chronic portal vein occlusion: long-term angiographic, hemodynamic, and clinical follow-up. Am J Gastroenterol 95:2966–2968CrossRefPubMedGoogle Scholar
  6. 6.
    Alkari B, Shaath NM, El-Dhuwaib Y et al (2005) Transjugular intrahepatic porto-systemic shunt and variceal embolisation in the management of bleeding stomal varices. Int J Colorectal Dis 20:457–462CrossRefPubMedGoogle Scholar
  7. 7.
    Carrafiello G, Lagana D, Giorgianni A et al (2007) Bleeding from peristomal varices in a cirrhotic patient with ileal conduit: treatment with transjugular intrahepatic portocaval shunt (TIPS). Emerg Radiol Mar 13:341–343CrossRefGoogle Scholar
  8. 8.
    Wong RC, Berg CL (1997) Portal hypertensive stomapathy: a newly described entity and its successful treatment by placement of a transjugular intrahepatic portosystemic shunt. Am J Gastroenterol Jun 92:1056–1057Google Scholar
  9. 9.
    Vidal V, Joly L, Perreault P, Bouchard L, Lafortune M, Pomier-Layrargues G (2006) Usefulness of transjugular intrahepatic portosystemic shunt in the management of bleeding ectopic varices in cirrhotic patients. Cardiovasc Intervent Radiol 29:216–219CrossRefPubMedGoogle Scholar
  10. 10.
    Vangeli M, Patch D, Terreni N et al (2004) Bleeding ectopic varices—treatment with transjugular intrahepatic porto-systemic shunt (TIPS) and embolisation. J Hepatol 41:560–566CrossRefPubMedGoogle Scholar
  11. 11.
    Spier BJ, Fayyad AA, Lucey MR et al (2008) Bleeding stomal varices: case series and systematic review of the literature. Clin Gastroenterol Hepatol 6:346–352CrossRefPubMedGoogle Scholar
  12. 12.
    Kishimoto K, Hara A, Arita T et al (1999) Stomal varices: treatment by percutaneous transhepatic coil embolization. Cardiovasc Intervent Radiol 22:523–525CrossRefPubMedGoogle Scholar
  13. 13.
    Macedo TA, Andrews JC, Kamath PS (2005) Ectopic varices in the gastrointestinal tract: short- and long-term outcomes of percutaneous therapy. Cardiovasc Intervent Radiol 28:178–184CrossRefPubMedGoogle Scholar
  14. 14.
    Samaraweera RN, Feldman L, Widrich WC et al (1989) Stomal varices: percutaneous transhepatic embolization. Radiology 170(3 Pt 1):779–782PubMedGoogle Scholar
  15. 15.
    Toumeh KK, Girardot JD, Choo IW, Andrews JC, Cho KJ (1995) Percutaneous transhepatic embolization as treatment for bleeding ileostomy varices. Cardiovasc Intervent Radiol 18:179–182CrossRefPubMedGoogle Scholar
  16. 16.
    Lashley DB, Saxon RR, Fuchs EF, Chin DH, Lowe BA (1997) Bleeding ileal conduit stomal varices: diagnosis and management using transjugular transhepatic angiography and embolization. Urology 50:612–614CrossRefPubMedGoogle Scholar
  17. 17.
    Konate A, Oberti F, Aube C et al (2007) Stomal varices treated by glue embolization. Gastroenterol Clin Biol 31:300–302PubMedCrossRefGoogle Scholar
  18. 18.
    Minami S, Okada K, Matsuo M, Kamohara Y, Sakamoto I, Kanematsu T (2007) Treatment of bleeding stomal varices by balloon-occluded retrograde transvenous obliteration. J Gastroenterol 42:91–95CrossRefPubMedGoogle Scholar
  19. 19.
    Hesterberg R, Stahlknecht CD, Roher HD (1968) Sclerotherapy for massive enterostomy bleeding resulting from portal hypertension. Dis Colon Rectum 29:275–277CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Sailen G. Naidu
    • 1
  • Erik P. Castle
    • 2
  • J. Scott Kriegshauser
    • 1
  • Eric A. Huettl
    • 1
  1. 1.Department of Radiology, Division of Interventional RadiologyMayo Clinic Arizona, Mayo Clinic HospitalPhoenixUSA
  2. 2.Department of UrologyMayo Clinic Arizona, Mayo Clinic HospitalPhoenixUSA

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