Treatment of bleeding stomal varices. Report of a case and review of the literature

Abstract

Variceal bleeding from ileostomy, colostomy, or ileal conduit stomas is unusual. There is no consensus on which of the various treatment options is best. A case of bleeding ileostomy varices is presented. The English-language medical literature since 1962 is reviewed and an additional 71 cases of stomal variceal bleeding are identified. Treatment options evaluated include stomal manipulation, variceal ligation, sclerotherapy, beta blockade, and surgical shunting. The incidence of rebleeding, requirement for additional procedures, and survival with the various options are compared. Although stomal manipulation was the most commonly performed procedure, portosystemic shunting had the lowest incidence of both rebleeding and need for additional procedures (4 percent each) and provided the longest mean postoperative survival (50 months). The authors conclude that portosystemic shunting is the treatment of choice in patients with bleeding from stomal varices who are good surgical candidates.