J Korean Soc Radiol.  2015 May;72(5):344-347. 10.3348/jksr.2015.72.5.344.

Balloon Occluded Retrograde Transvenous Obliteration of Bleeding Stomal Varices Using Sodium Tetradecyl Sulfate Foam: A Case Report

• Kim J
• Yang P
• Lee Y
• Kim H
• Park G

• KMID: 1793891
• DOI: http://doi.org/10.3348/jksr.2015.72.5.344

Abstract

A stomal varix is an uncommon complication with a high mortality rate occurring secondary to portal hypertension in patients with a stoma. We describe a case of recurrent stomal varix bleeding successfully managed by balloon occluded retrograde transvenous obliteration using sodium tetradecyl sulfate foam.

MeSH Terms

Hemorrhage*
Humans
Hypertension, Portal
Mortality
Sodium Tetradecyl Sulfate*
Varicose Veins*
Sodium Tetradecyl Sulfate

Figure

• 

  Fig. 1 Computed tomography of abdomen (A, B) shows stomal varix at left lower quadrant abdominal wall and inflow vein (arrow in B) arising from inferior mesenteric vein (IMV). Reconstructed CT angiogram (C) shows varix (arrowheads), inflow vein from IMV (white arrow) and out flow vein drain to left femoral vein (black arrow).

• 

  Fig. 2 Varix and inflow veins are not visualized due to collateral competing veins at the initial venogram (A). After coil embolization of competing collateral veins (arrows) and manual compression of small remaining superficial collateral veins, retrograde venogram clearly demonstrates varices and inflow vein (B). Fluoroscopy image obtained immediately after STS foam infusion (C) sclerosant filled varices (arrow) and partially visualized inflow vein (arrowhead). STS = sodium tetradecyl sulfate

• 

  Fig. 3 Follow-up CT obtained after 1.5 years after sclerotherapy shows near completely obliterated stomal varices (arrow in A) and inflow vein (arrow in B).

Reference

1. Norton ID, Andrews JC, Kamath PS. Management of ectopic varices. Hepatology. 1998; 28:1154–1158.

2. Naidu SG, Castle EP, Kriegshauser JS, Huettl EA. Direct percutaneous embolization of bleeding stomal varices. Cardiovasc Intervent Radiol. 2010; 33:201–204.

3. Thouveny F, Aubé C, Konaté A, Lebigot J, Bouvier A, Oberti F. Direct percutaneous approach for endoluminal glue embolization of stomal varices. J Vasc Interv Radiol. 2008; 19:774–777.

4. Noubibou M, Douala HC, Druez PM, Kartheuzer AH, Detry RJ, Geubel AP. Chronic stomal variceal bleeding after colonic surgery in patients with portal hypertension: efficacy of beta-blocking agents? Eur J Gastroenterol Hepatol. 2006; 18:807–808.

5. Spier BJ, Fayyad AA, Lucey MR, Johnson EA, Wojtowycz M, Rikkers L, et al. Bleeding stomal varices: case series and systematic review of the literature. Clin Gastroenterol Hepatol. 2008; 6:346–352.

6. Minami S, Okada K, Matsuo M, Kamohara Y, Sakamoto I, Kanematsu T. Treatment of bleeding stomal varices by balloon-occluded retrograde transvenous obliteration. J Gastroenterol. 2007; 42:91–95.

7. Vangeli M, Patch D, Terreni N, Tibballs J, Watkinson A, Davies N, et al. Bleeding ectopic varices--treatment with transjugular intrahepatic porto-systemic shunt (TIPS) and embolisation. J Hepatol. 2004; 41:560–566.

8. Calabrese E, Hanauer SB. Assessment of non-cirrhotic portal hypertension associated with thiopurine therapy in inflammatory bowel disease. J Crohns Colitis. 2011; 5:48–53.