Transvenous Obliteration Procedure in the Management of Parastomal Variceal Bleeding: A Case Report

Detalhes bibliográficos
Autor(a) principal: Estorninho, João
Data de Publicação: 2022
Outros Autores: Patrão, Pedro, Temido, Maria José, Perdigoto, David, Figueiredo, Pedro, Donato, Paulo
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10316/100584
https://doi.org/10.1159/000521325
Resumo: Introduction: Parastomal variceal bleeding (PVB) is a recognized complication of ostomized patients in the presence of portal hypertension. However, since there are few reported cases, a therapeutic algorithm has not yet been established. Case Presentation: A 63-year-old man, who had undergone a definitive colostomy, recurrently presented to the emergency department hemorrhage of bright red blood from his colostomy bag, initially assumed to be caused by stoma trauma. Accordingly, temporary success on local approaches such as direct compression, silver nitrate application and suture ligation was achieved. However, bleeding recurred, requiring transfusion of red blood cell concentrate and hospitalization. The patient's evaluation showed chronic liver disease with massive collateral circulation, particularly at the colostomy site. After a PVB with associated hypovolemic shock, the patient was submitted to a balloon-occluded retrograde transvenous obliteration (BRTO) procedure which stopped the bleeding successfully. The patient was subsequently proposed for a transjugular intrahepatic portosystemic shunt (TIPS) conjugated with percutaneous transhepatic obliteration (PTO). After an initial refusal by the patient, a new episode of self-limited PVB resulted in execution of the procedure. Four months later, in a routine consultation, the patient presented with grade II hepatic encephalopathy, successfully treated with medical therapy. After a 9-month follow-up, he remained clinically well and without further episodes of PVB or other adverse effects. Discussion: This report highlights the importance of a high index of suspicion when dealing with significant stomal hemorrhage. Portal hypertension as an etiology of this entity may compel to a specific approach to prevent recurrence of bleeding, including conjugation of endovascular procedures. The authors pre-sent a case of PVB, initially submitted to a variety of treatment options including BRTO, which was successfully addressed with conjugated treatment of TIPS and PTO.
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spelling Transvenous Obliteration Procedure in the Management of Parastomal Variceal Bleeding: A Case ReportParastomal varicesBalloon-occluded retrograde transvenous obliterationTransjugular intrahepatic portosystemic shuntIntroduction: Parastomal variceal bleeding (PVB) is a recognized complication of ostomized patients in the presence of portal hypertension. However, since there are few reported cases, a therapeutic algorithm has not yet been established. Case Presentation: A 63-year-old man, who had undergone a definitive colostomy, recurrently presented to the emergency department hemorrhage of bright red blood from his colostomy bag, initially assumed to be caused by stoma trauma. Accordingly, temporary success on local approaches such as direct compression, silver nitrate application and suture ligation was achieved. However, bleeding recurred, requiring transfusion of red blood cell concentrate and hospitalization. The patient's evaluation showed chronic liver disease with massive collateral circulation, particularly at the colostomy site. After a PVB with associated hypovolemic shock, the patient was submitted to a balloon-occluded retrograde transvenous obliteration (BRTO) procedure which stopped the bleeding successfully. The patient was subsequently proposed for a transjugular intrahepatic portosystemic shunt (TIPS) conjugated with percutaneous transhepatic obliteration (PTO). After an initial refusal by the patient, a new episode of self-limited PVB resulted in execution of the procedure. Four months later, in a routine consultation, the patient presented with grade II hepatic encephalopathy, successfully treated with medical therapy. After a 9-month follow-up, he remained clinically well and without further episodes of PVB or other adverse effects. Discussion: This report highlights the importance of a high index of suspicion when dealing with significant stomal hemorrhage. Portal hypertension as an etiology of this entity may compel to a specific approach to prevent recurrence of bleeding, including conjugation of endovascular procedures. The authors pre-sent a case of PVB, initially submitted to a variety of treatment options including BRTO, which was successfully addressed with conjugated treatment of TIPS and PTO.2022info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttp://hdl.handle.net/10316/100584http://hdl.handle.net/10316/100584https://doi.org/10.1159/000521325eng2341-45452387-1954Estorninho, JoãoPatrão, PedroTemido, Maria JoséPerdigoto, DavidFigueiredo, PedroDonato, Pauloinfo:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2022-07-05T20:31:00Zoai:estudogeral.uc.pt:10316/100584Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T21:17:56.472702Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Transvenous Obliteration Procedure in the Management of Parastomal Variceal Bleeding: A Case Report
title Transvenous Obliteration Procedure in the Management of Parastomal Variceal Bleeding: A Case Report
spellingShingle Transvenous Obliteration Procedure in the Management of Parastomal Variceal Bleeding: A Case Report
Estorninho, João
Parastomal varices
Balloon-occluded retrograde transvenous obliteration
Transjugular intrahepatic portosystemic shunt
title_short Transvenous Obliteration Procedure in the Management of Parastomal Variceal Bleeding: A Case Report
title_full Transvenous Obliteration Procedure in the Management of Parastomal Variceal Bleeding: A Case Report
title_fullStr Transvenous Obliteration Procedure in the Management of Parastomal Variceal Bleeding: A Case Report
title_full_unstemmed Transvenous Obliteration Procedure in the Management of Parastomal Variceal Bleeding: A Case Report
title_sort Transvenous Obliteration Procedure in the Management of Parastomal Variceal Bleeding: A Case Report
author Estorninho, João
author_facet Estorninho, João
Patrão, Pedro
Temido, Maria José
Perdigoto, David
Figueiredo, Pedro
Donato, Paulo
author_role author
author2 Patrão, Pedro
Temido, Maria José
Perdigoto, David
Figueiredo, Pedro
Donato, Paulo
author2_role author
author
author
author
author
dc.contributor.author.fl_str_mv Estorninho, João
Patrão, Pedro
Temido, Maria José
Perdigoto, David
Figueiredo, Pedro
Donato, Paulo
dc.subject.por.fl_str_mv Parastomal varices
Balloon-occluded retrograde transvenous obliteration
Transjugular intrahepatic portosystemic shunt
topic Parastomal varices
Balloon-occluded retrograde transvenous obliteration
Transjugular intrahepatic portosystemic shunt
description Introduction: Parastomal variceal bleeding (PVB) is a recognized complication of ostomized patients in the presence of portal hypertension. However, since there are few reported cases, a therapeutic algorithm has not yet been established. Case Presentation: A 63-year-old man, who had undergone a definitive colostomy, recurrently presented to the emergency department hemorrhage of bright red blood from his colostomy bag, initially assumed to be caused by stoma trauma. Accordingly, temporary success on local approaches such as direct compression, silver nitrate application and suture ligation was achieved. However, bleeding recurred, requiring transfusion of red blood cell concentrate and hospitalization. The patient's evaluation showed chronic liver disease with massive collateral circulation, particularly at the colostomy site. After a PVB with associated hypovolemic shock, the patient was submitted to a balloon-occluded retrograde transvenous obliteration (BRTO) procedure which stopped the bleeding successfully. The patient was subsequently proposed for a transjugular intrahepatic portosystemic shunt (TIPS) conjugated with percutaneous transhepatic obliteration (PTO). After an initial refusal by the patient, a new episode of self-limited PVB resulted in execution of the procedure. Four months later, in a routine consultation, the patient presented with grade II hepatic encephalopathy, successfully treated with medical therapy. After a 9-month follow-up, he remained clinically well and without further episodes of PVB or other adverse effects. Discussion: This report highlights the importance of a high index of suspicion when dealing with significant stomal hemorrhage. Portal hypertension as an etiology of this entity may compel to a specific approach to prevent recurrence of bleeding, including conjugation of endovascular procedures. The authors pre-sent a case of PVB, initially submitted to a variety of treatment options including BRTO, which was successfully addressed with conjugated treatment of TIPS and PTO.
publishDate 2022
dc.date.none.fl_str_mv 2022
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http://hdl.handle.net/10316/100584
https://doi.org/10.1159/000521325
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https://doi.org/10.1159/000521325
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2387-1954
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