Transileocolic vein obliteration for bleeding rectal varices with portal thrombus

Abstract

We report a case of rectal varices treated successfully with transileocolic vein obliteration (TIO). A 70-year-old man was admitted to our hospital for evaluation of fresh bloody stools in January 2011. Emergent colonoscopy revealed fresh blood in the rectum and tortuous rectal varices. Three-dimensional computed tomography was used as a non-invasive method for the identification of rectal varices and thrombus in the extrahepatic portal vein. Angiography demonstrated that rectal varices were supplied with backward blood flow by the inferior mesenteric vein. Transileocolic variceal obliteration was performed using coils and 5% ethanolamine oleate with iopamidol. Complete hemostasis was achieved without complications. We conclude that TIO is a safe and effective hemostatic measure for ruptured rectal varices with portal thrombus.

Keywords: Portal thrombus; Rectal varices; Transileocolic vein obliteration.

Fig. 1

On 3D-CT, the IMV (arrow) and internal iliac vein (arrowhead) are identifiable as the feeding and drainage vessels, respectively, of the rectal varices.

Fig. 2

Thrombus formation (arrow) inside the portal vein is seen on contrast-enhanced CT.

Fig. 3

Portography during balloon occlusion of the blood flow in the IMV demonstrates that the rectal varices (arrow) are supplied with backward blood flow by the IMV and flow into the internal iliac vein (arrowhead). The sclerosant was injected through the balloon catheter into the IMV.