Ahn SS, Kim EH, Kim MD, Lee WJ, Kim SU. Successful hemostasis of intractable rectal variceal bleeding using variceal embolization. World J Gastroenterol 2015; 21(8): 2558-2562 [PMID: 25741168 DOI: 10.3748/wjg.v21.i8.2558]
Corresponding Author of This Article
Seung Up Kim, MD, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea. ksukorea@yuhs.ac
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Feb 28, 2015; 21(8): 2558-2562 Published online Feb 28, 2015. doi: 10.3748/wjg.v21.i8.2558
Successful hemostasis of intractable rectal variceal bleeding using variceal embolization
Sung Soo Ahn, Eun Hye Kim, Man Deuk Kim, Won Jae Lee, Seung Up Kim
Sung Soo Ahn, Eun Hye Kim, Seung Up Kim, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 120-752, South Korea
Man Deuk Kim, Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, South Korea
Won Jae Lee, Seoul Gookgwain School, Seoul 110-521, South Korea
Seung Up Kim, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, South Korea
Seung Up Kim, Liver Cirrhosis Clinical Research Center, Seoul 120-752, South Korea
Author contributions: Ahn SS designed the report and wrote the paper; Kim MD designed the concept and performed varceal embolization; Kim EH and Lee WJ drafted the article and revised it; Kim SU designed the concept and finally approved the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Seung Up Kim, MD, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea. ksukorea@yuhs.ac
Telephone: +82-2-22281982 Fax: +82-2-3936884
Received: May 26, 2014 Peer-review started: May 26, 2014 First decision: June 18, 2014 Revised: June 26, 2014 Accepted: July 22, 2014 Article in press: July 22, 2014 Published online: February 28, 2015 Processing time: 278 Days and 4.7 Hours
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.
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.
