Successful Transjugular Intrahepatic Portosystemic Shunt with Embolization Subsequent to Endoscopic Variceal Band Ligation for Bleeding Anorectal Varices

Sang Woo Park; Chung Hwan Jun; Sung Kyu Choi; Hyun Soo Kim; Chang Hwan Park; Jong Sun Rew; Seon Young Park; Eunae Cho; Jae Kyu Kim; Hyoung Ook Kim

doi:10.4166/kjg.2018.71.4.234

Journal List > Korean J Gastroenterol > v.71(4) > 1007758

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Park, Jun, Choi, Kim, Park, Rew, Park, Cho, Kim, and Kim: Successful Transjugular Intrahepatic Portosystemic Shunt with Embolization Subsequent to Endoscopic Variceal Band Ligation for Bleeding Anorectal Varices

Case Report

Korean J Gastroenterol 2018;71(4):234-238.

Published online: 4 October 2018

DOI: https://doi.org/10.4166/kjg.2018.71.4.234

Successful Transjugular Intrahepatic Portosystemic Shunt with Embolization Subsequent to Endoscopic Variceal Band Ligation for Bleeding Anorectal Varices

Sang Woo Park, Chung Hwan Jun, Sung Kyu Choi, Hyun Soo Kim, Chang Hwan Park, Jong Sun Rew, Seon Young Park, Eunae Cho, Jae Kyu Kim¹, Hyoung Ook Kim¹

Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea

¹Department of Radiology, Chonnam National University Medical School, Gwangju, Korea

Correspondence to: Sung Kyu Choi, Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, 42 Jaebong-ro, Dong-gu, Gwangju 61469, Korea. Tel: +82-62-220-6215, Fax: +82-62-225-8578, E-mail: choisk@jnu.ac.kr

Received 2 November 2017 Revised 8 February 2018 Accepted 8 February 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Anorectal variceal bleeding is a rare occurrence; however, in such event, it could be fatal due to large size and high blood flow rate of varices. However, to date, there is no standardized treatment modality. Although endoscopic treatment can be provided, in cases of recurrent anorectal variceal bleeding, other therapeutic modalities for hemostasis are necessary. Here, we present a case of 58-year-old female patient with liver cirrhosis, who suffered from massive bleeding of anorectal varices. Endoscopic variceal band ligation was performed for primary hemostasis. Additionally, transjugular intrahepatic portosystemic shunt (TIPS) with embolization was performed to reduce the risk of rebleeding. Following the procedure, she had no further bleeding episodes, and the size of anorectal varices decreased, as seen on an abdominopelvic computed tomography. Our case illustrates the effectiveness of combined radiological intervention of TIPS with embolization after endoscopic hemostasis, for variceal obliteration and prevention of rebleeding.

Keywords: Varices, Treatment, Hemostasis, Portosystemic shunt, Portal hypertension

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Fig. 1.

Sigmoidoscopic finding. Huge anorectal varices (A) and stigmata of recent hemorrhage near the dentate line (B). Endoscopic variceal band ligation was performed to prevent further rebleeding (C).

Fig. 2.

An abdominopelvic computed tomography (CT) showing. Huge and tortuous varices in the anorectal region and large amount of ascites in the abdominopelvic cavity (A, B). A follow-up abdominopelvic CT two weeks after TIPS with embolization showed marked improvement of anorectal varices with a decrease in ascites (C, D).

Fig. 3.

Portal venogram (contrastenhanced series) obtained after inferior mesenteric vein (IMV) cannulation. Anorectal varices being fed by the tortuous and dilated superior rectal branches arising from the IMV (A). Embolization was performed at both ends of the superior rectal branches using 8 mm Amplatzer vascular plugs (arrowheads) (B).

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