Abstract
BackgroundEctopic varices are uncommon and typically due to underlying liver cirrhosis. They can be located in the duodenum, small intestines, colon or rectum, and may result in massive haemorrhage. While established guidelines exist for the management of oesophageal and gastric variceal bleeding, this is currently lacking for colonic varices.Beta-blockers, transjugular intrahepatic portosystemic shunt insertion and subtotal colectomy have been reported as management methods. However, there are only two other cases that have reported successfully treating colonic varices using balloon-occluded retrograde transvenous obliteration (BRTO), an endovascular procedure typically performed for gastric varices.Case presentationA 55-year-old man with background of alcoholic liver cirrhosis presented with per-rectal bleeding due to caecal varices. Grade 2–3 oesophageal varices were identified on oesophago-gastro-duodenoscopy, and computed tomography showed multiple right para-colic portosystemic collaterals around the hepatic flexure and ascending colon. Colonoscopy confirmed fresh blood in the colon up to the caecum, with a submucosal varix deemed the most likely source of haemorrhage.As transjugular intrahepatic portosystemic shunt insertion was potentially technically difficult, due to left portal vein thrombosis and a small right portal venous system, he underwent BRTO, which successfully embolised and thrombosed the colonic varices without complications.ConclusionsWhilst further studies are required to conclude its effectiveness and efficacy, BRTO may be considered a viable solution in managing ectopic, colonic, variceal haemorrhage especially when traditional techniques are unsuccessful or contraindicated.
Highlights
Ectopic varices are uncommon and typically due to underlying liver cirrhosis
Whilst further studies are required to conclude its effectiveness and efficacy, balloon-occluded retrograde transvenous obliteration (BRTO) may be considered a viable solution in managing ectopic, colonic, variceal haemorrhage especially when traditional techniques are unsuccessful or contraindicated
We describe a case of caecal variceal bleeding in a patient with liver cirrhosis who presented with per-rectal bleeding
Summary
Ectopic varices are portosystemic venous collaterals that result from portal hypertension occurring in any location other than the oesophageal or gastric region (Norton et al 1998). We describe a case of caecal variceal bleeding in a patient with liver cirrhosis who presented with per-rectal bleeding This was treated with balloon-occluded retrograde transvenous obliteration (BRTO), an endovascular. The patient was transferred to the intensive care unit where he was intubated, and oesophago-gastroduodenoscopy was subsequently performed This revealed four columns of grade 2–3 oesophageal varices with red wale signs (i.e. longitudinal red streaks on the varices), portal hypertensive gastropathy and a small duodenal ulcer, but no active bleeding. The patient was administered intravenous vasopressin (Terlipressin 2 mg 4-hourly), a beta blocker (Carvedilol titrated up to 18.75 mg twice daily) and multiple units of platelets, packed cells and fresh frozen plasma His haemoglobin improved to 8.4 g/dl and he remained haemodynamically stable for the few days. His Hb levels remained stable at 8.7 g/dl and there were no further episodes
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
