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; Rectal varices; Transjugular intravenous portosystemic shunt; Embolization; Variceal bleeding

Core tip: In intractable rectal variceal bleeding, transjugular intrahepatic portosystemic shunt (TIPS) has been shown to be an effective method for hemostasis. However, in recurrent bleeding even after successful TIPS, no solid therapeutic approach is available, and various measures should be tried according to clinical conditions. This case report reviews the traditional role of TIPS in rectal variceal bleeding, but also implies the role of variceal embolization in recurrent rectal variceal bleeding even after successful TIPS.