Treating Untreatable Rectal Varices

Mónica Garrido; Belarmino Gonçalves; Sofia Ferreira; Marta Rocha; Marta Salgado; Isabel Pedroto

doi:10.1159/000496121

Treating Untreatable Rectal Varices

GE Port J Gastroenterol. 2019 Oct;26(6):420-424. doi: 10.1159/000496121. Epub 2019 Feb 15.

Authors

Mónica Garrido¹, Belarmino Gonçalves², Sofia Ferreira³, Marta Rocha¹, Marta Salgado^{1

4}, Isabel Pedroto^{1

4}

Affiliations

¹ Department of Gastroenterology, Porto University Hospital Centre, Porto, Portugal.
² Department of Interventional Radiology, Portuguese Oncology Institute, Porto, Portugal.
³ Liver Transplant Unit, Porto University Hospital Centre, Porto, Portugal.
⁴ Institute of Biomedical Sciences of Abel Salazar (ICBAS), University of Porto, Porto, Portugal.

Abstract

Background: Rectal varices are portosystemic collaterals that arise as a complication of portal hypertension. Despite their significant prevalence among cirrhotic patients, clinically important bleeding occurs only in a minority. Various treatment options are available, with endoscopic therapies being widely used, and both interventional radiology and surgery being considered for refractory bleeding rectal varices.

Case: We report the case of a 61-year-old male with hepatic cirrhosis and bleedingrectal varices refractory to endoscopic therapy, successfully managed with a combination of transjugular intrahepatic portosystemic shunt (TIPS) and selective variceal embolization.

Conclusions: Radiological techniques are effective options for refractory bleeding. Adding embolization to TIPS implantation could represent a valid adjunctive measure for haemostasis of recurrent rectal variceal bleeding.

Keywords: Liver cirrhosis; Rectal varices; Therapeutic embolization; Transjugular intrahepatic portosystemic shunt.

Publication types

Case Reports