Published online Jan 16, 2016. doi: 10.12998/wjcc.v4.i1.25
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
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.