Successful hemostasis of intractable rectal variceal bleeding using variceal embolization

Abstract

Portal hypertension causes portosystemic shunting along the gastrointestinal tract, resulting in gastrointestinal varices. Rectal varices and their bleeding is a rare complication, but it can be fatal without appropriate treatment. However, because of its rarity, no established treatment strategy is yet available. In the setting of intractable rectal variceal bleeding, a transjugular intravenous portosystemic shunt can be a treatment of choice to enable portal decompression and thus achieve hemostasis. However, in the case of recurrent rectal variceal bleeding despite successful transjugular intravenous portosystemic shunt, alternative measures to control bleeding are required. Here, we report on a patient with liver cirrhosis who experienced recurrent rectal variceal bleeding even after successful transjugular intravenous portosystemic shunt and was successfully treated with variceal embolization.

Keywords: Ectopic varices; Embolization; Rectal varices; Transjugular intravenous portosystemic shunt; Variceal bleeding.

Figure 1

Computed tomography. A: Abdominopelvic computed tomography. Huge rectal varices protrude into the rectum; B: Follow-up computed tomography at 5 d after variceal embolization. Obliteration of rectal varices is identified.

Figure 2

Sigmoidoscopic examination. Huge rectal varices protrude into the rectum, with bleeding.

Figure 3

Angiography. After applying an occlusion balloon (white dotted arrow) and vascular plug (black arrow), variceal embolization was successfully performed using a Gelfoam pledget (white arrow).