Endovascular management of bleeding peristomal varices

Abstract

Bleeding from the peristomal varices is a rare recognised complication of stoma creation following proctocolectomy in a case of inflammatory bowel disease and associated sclerosing cholangitis. Peri-stomal varices are uncommon site of porto-systemic collateral formation in cases of pre-exiting portal hypertension and eventually a potential site of variceal bleeding. The management of peristomal variceal bleeding includes local compression, ligation, sclerotherapy and percutaneous variceal embolization; however these procedures are associated with high rate of recurrence because of the persistent raised portal venous pressure. Transjugular intrahepatic portosystemic shunt (TIPSS) is an artificial shunt created to reduce the raised portal venous pressure and can be used for the immediate relief of bleeding from peristomal varices. We are reporting a case of peristomal varices managed by transjugular intrahepatic porto-systemic shunt creation followed by coil embolization of peristomal varices and subsequently review the literature related to its management.