Successful treatment of intractable rectal varices with Gelfoam slurry embolisation and coiling
  • Justine Auxilia Irene Chinnappan
    Department of Internal Medicine, Michigan State University at Hurley Medical Center, Flint, MI, USA https://orcid.org/0000-0002-6643-2549
  • Murtaza Shabbir
    Department of Internal Medicine, Michigan State University at Hurley Medical Center, Flint, MI, USA
  • Smit Deliwala
    Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA
  • Anish Bansal
    Department of Interventional Radiology, Michigan State University at Hurley Medical Center, Flint, MI, USA

Keywords

Rectal varices, embolisation, varices coiling

Abstract

A 57-year-old male with heart failure and decompensated alcoholic liver cirrhosis presented with recurrent haematochesia due to rectal varices. After multiple failed therapy with endoscopic band ligation and surgical sclerotherapy, a discussion with an interventional radiologist was arranged. A transjugular intrahepatic portosystemic shunt (TIPS) was deferred due to a history of heart failure. A shared decision to proceed with transhepatic Gelfoam® slurry embolisation with coiling was made. During the procedure, a variant anatomy of the superior rectal vein was identified. The superior rectal vein was found to drain directly into the left portal vein with no connectivity between the inferior mesenteric vein and the rectal varices. As planned, Gelfoam slurry embolisation and coiling was done to the left and right superior rectal vein along with the common trunk it drains. The patient did not develop any further episodes of gastrointestinal bleeding or worsening ascites on follow-up after 6 months. This case represents a successful treatment of bleeding rectal varices when TIPS is contraindicated.

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References

  • Helmy A, Al Kahtani K, Al Fadda M. Updates in the pathogenesis, diagnosis and management of ectopic varices. Hepatol Int 2008;2:322–334.
  • Watanabe N, Toyonaga A, Kojima S, Takashimizu S, Oho K, Kokubu S, et al. Current status of ectopic varices in Japan: Results of a survey by the Japan Society for Portal Hypertension. Hepatol Res 2010;40:763–776.
  • Hosking SW, Smart HL, Johnson AG, Triger DR. Anorectal varices, haemorrhoids, and portal hypertension. Lancet 1989;1:349–352.
  • Yoshino K, Imai Y, Nakazawa M, Chikayama T, Ando S, Sugawara K, et al. Therapeutic strategy for patients with bleeding rectal varices complicating liver cirrhosis. Hepatol Res 2014;44:1088–1094.
  • Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology 2017;65:310–335.
  • Sato T, Yamazaki K, Akaike J, Toyota J, Karino Y, Ohmura T. Retrospective analysis of endoscopic injection sclerotherapy for rectal varices compared with band ligation. Clin Exp Gastroenterol 2010;3:159–163.
  • Al Khalloufi K, Laiyemo AO. Management of rectal varices in portal hypertension. World J Hepatol 2015;7:2992–2998.
  • Rhanemai-Azar AA, Rajdev M, Ismail M, McLoney ED, Tavri S, Al-Natour MS. Role of interventional radiology in intractable bleeding rectal varices. Abdom Radiol (NY) 2021;46:1163–1170.
  • Saad WEA. Balloon-occluded retrograde transvenous obliteration of gastric varices: concept, basic techniques, and outcomes. Semin Intervent Radiol 2012;29:118–128.
  • Tarasconi A, Perrone G, Davies J, Coimbra R, Moore E, Azzaroli F, et al. Anorectal emergencies: WSES-AAST guidelines. World J Emerg Surg 2021;16:48.
  • Maslekar S, Toh E-W, Adair R, Bate JP, Botterill I. Systematic review of anorectal varices. Colorectal Dis 2013;15:e702–710.

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    Published: 2023-06-12
    Issue: 2023: Vol 10 No 7 (view)

    How to cite:
    1.
    Chinnappan JAI, Shabbir M, Deliwala S, Bansal A. Successful treatment of intractable rectal varices with Gelfoam slurry embolisation and coiling. EJCRIM 2023;10 doi:10.12890/2023_003930.

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