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- Title
Intractable parastomal bleeding in a portal hypertensive patient managed by direct sclerotherapy: a case report.
- Authors
Yazdi, Niloofar Ayoobi; Aletaha, Najmeh; Mehrabinejad, Mohammad-Mehdi; Dehnavi, Ali Zare; Yazdi, Hadi Rokni
- Abstract
Patients with a stoma have 5% chance of developing parastomal varices, which tend to repetitive massive and life-threatening hemorrhages. Treatment of choice in parastomal varices have not been established, while Transjugular Intrahepatic Portosystemic Shunt (TIPS) has been revealed as the most successful measure. We report a hemodynamically unstable patient with a history of Ulcerative Colitis (UC) and Primary Sclerosing Cholangitis (PSC) with colostomy, because of colon cancer who presented with massive parastomal bleeding. Non-operative treatments and TIPS failed to control the symptoms. Color Doppler ultrasound showed a hepato-fugal flow. The direct antegrade technique, using Sodium Tetradecyl Sulfate (STS 1%) and glue-Lipiodol, was applied under ultrasonography guidance, and complete stoppage of bleeding was achieved. No immediate or late complication or follow-up recurrence were noted after 8 months. In case of hepatofugal flow, direct percutaneous mesenteric parastomal venous access and sclerotherapy is a rapid and relatively safe procedure for parastomal variceal bleeding.
- Subjects
SURGICAL arteriovenous shunts; ESOPHAGEAL varices; GASTROINTESTINAL hemorrhage; HEMODYNAMICS; SCLEROTHERAPY; PORTAL hypertension; COLOR Doppler ultrasonography
- Publication
Gastroenterology & Hepatology from Bed to Bench, 2020, Vol 13, Issue 1, p90
- ISSN
2008-2258
- Publication type
Article