Patients with liver cirrhosis frequently experience rectal variceal bleeding subsequent to portal hypertension. Unlike gastroesophageal variceal bleeding, a well-established guideline does not exist in terms of management of bleeding rectal varices. A 75-year-old male with non-alcoholic-steatohepatitis induced cirrhosis presented with a 3-day history of severe rectorrhagia. Considering patient's clinical history, TIPS was not performed and thus, a novel endovascular technique termed balloon-occluded antegrade transvenous obliteration was considered. Under conscious sedation, an occlusion was made through balloon catheter by sclerotic agents including air/sodium tetradecyl sulfate/Lipiodol. After the procedure, and in the 6 months follow up period the patient's hemodynamic status was stable and he recovered without any serious complications. Balloon-occluded antegrade transvenous obliteration is a feasible and safe modality for treating rectal varices bleeding and could be used as an alternative approach in patients with contraindications to traditional treatments.
Keywords: AVP2, amplatzer vascular plug 2; BATO; BATO, balloon-occluded antegrade transvenous obliteration; BRTO, balloon-occluded retrograde transvenous obliteration; CT, computed tomography; EIS, endoscopic injection sclerotherapy; EUS, endoscopic ultrasound; FFP, fresh frozen plasma; HIPAA, Health Insurance Portability and Accountability Act; ICU, intensive care unit; IMV, inferior mesenteric vein; NAFLD, non-alcoholic fatty liver disease; Percutaneous transhepatic obliteration; Portal hypertension; Rectal varices; SMV, superior mesenteric vein; STS, sodium tetradecyl sulfate; Sclerotherapy; TIPS, trans-jugular intrahepatic portosystemic shunt; US, ultrasound; Variceal bleeding.
© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.