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Case Reports
. 2019 Oct;26(6):420-424.
doi: 10.1159/000496121. Epub 2019 Feb 15.

Treating Untreatable Rectal Varices

Mónica Garrido  1 , Belarmino Gonçalves  2 , Sofia Ferreira  3 , Marta Rocha  1 , Marta Salgado  1   4 , Isabel Pedroto  1   4
Affiliations
Case Reports

Treating Untreatable Rectal Varices

Mónica Garrido et al. GE Port J Gastroenterol. 2019 Oct.

Abstract

Background: Rectal varices are portosystemic collaterals that arise as a complication of portal hypertension. Despite their significant prevalence among cirrhotic patients, clinically important bleeding occurs only in a minority. Various treatment options are available, with endoscopic therapies being widely used, and both interventional radiology and surgery being considered for refractory bleeding rectal varices.

Case: We report the case of a 61-year-old male with hepatic cirrhosis and bleedingrectal varices refractory to endoscopic therapy, successfully managed with a combination of transjugular intrahepatic portosystemic shunt (TIPS) and selective variceal embolization.

Conclusions: Radiological techniques are effective options for refractory bleeding. Adding embolization to TIPS implantation could represent a valid adjunctive measure for haemostasis of recurrent rectal variceal bleeding.

Keywords: Liver cirrhosis; Rectal varices; Therapeutic embolization; Transjugular intrahepatic portosystemic shunt.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Colonoscopy findings after the second bleeding episode. a Enlarged and nodular rectal varices >20 mm with a ruptured point despite no active bleeding. b Congested internal haemorrhoids.
Fig. 2
Fig. 2
Sigmoidoscopy findings 1 week after the first endoscopic injection sclerotherapy. Rectal varices before (a) and after (b) endoscopic injection sclerotherapy with 1% polidocanol.
Fig. 3
Fig. 3
Fluoroscopic (a) and digital subtraction angiography (b) control after trans­jugular intrahepatic portosystemic shunt placement.
Fig. 4
Fig. 4
a Embolized rectal varices with ethylene vinyl alcohol and coils (procedure made across the transjugular intrahepatic portosystemic shunt tract – transjugular approach). A balloon is placed in the right hypogastric vein (left femoral approach). b Fluoroscopic control during Amplatzer plug deployment in the mesenteric renal shunt.
Fig. 5
Fig. 5
Sigmoidoscopy (a) and rectal endoscopic ultrasound (b) at 6 weeks of follow-up with no evidence of rectal varices or collateral circulation.
See this image and copyright information in PMC

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