World J Clin Cases. Jan 16, 2016; 4(1): 25-29 Published online Jan 16, 2016. doi: 10.12998/wjcc.v4.i1.25
Peristomal variceal bleeding treated by coil embolization using a percutaneous transhepatic approach
Macello José Sampaio Maciel, Osvaldo Ignácio Pereira, Joaquim Maurício Motta Leal Filho, Enio Ziemiecki Junior, Susyanne Lavor Cosme, Moisés Amâncio Souza, Francisco Cesar Carnevale
Macello José Sampaio Maciel, Osvaldo Ignácio Pereira, Joaquim Maurício Motta Leal Filho, Enio Ziemiecki Junior, Susyanne Lavor Cosme, Moisés Amâncio Souza, Francisco Cesar Carnevale, Radiology Department of Heart Institute, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-900, Brazil
Author contributions: Maciel MJS, Pereira OI and Motta Leal Filho JM designed the research and analysed the data; Maciel MJS, Pereira OI, Motta Leal Filho JM, Ziemiecki Junior E, Cosme SL and Souza MA performed the research; Maciel MJS, Pereira OI, Motta Leal Filho JM and Carnevale FC wrote the paper.
Institutional review board statement: This case report was reviewed and approved by the University of Sao Paolo - Brazil Institutional Review Board.
Informed consent statement: The patient involved in this study gave her written informed consent authorizing use and disclosure of her protected health information.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Correspondence to: Joaquim Maurício Motta Leal Filho, MD, PhD, Radiology Department of Heart Institute, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, Pinheiros, São Paulo 05403-900, Brazil. jotamauf@yahoo.com.br
Telephone: +55-11-26615492
Received: April 28, 2015 Peer-review started: May 6, 2015 First decision: September 8, 2015 Revised: October 14, 2015 Accepted: November 10, 2015 Article in press: November 11, 2015 Published online: January 16, 2016 Processing time: 261 Days and 5.7 Hours
Abstract
Peristomal variceal bleeding due to portal hypertension is an entity that has rarely been reported with 3%-4% risk of death. A 68-year-old woman who had undergone a palliative colostomy (colorectal carcinoma) presented with a massive hemorrhage from the colostomy conduit. Considering her oncological status with medial and right hepatic veins thrombosis due to liver metastasis invasion, an emergency transhepatic coil embolization was successfully performed. Standard treatment modality for these cases has not been established. Percutaneous transhepatic coil embolization of varices is a safe and effective choice in patients who present with life threatening bleeding and exhibit contraindications to transjugular intrahepatic portosystemic shunt.
Core tip: Peristomal variceal bleeding in patients with portal hypertension is a rare entity with increased risk of death. In situations when life-saving procedures are required in such patients, standard treatment modality has not been established. We illustrate a successfully performed emergency transhepatic coil embolization of bleeding varices in an oncological patient with contraindications to transjugular intrahepatic portosystemic shunt. Additionally, we discuss other different treatment options described in the literature and its technical challenges.
