Abstract
BackgroundColonic varices are rare among ectopic varices. A previous report demonstrated that once bleeding from colonic varices occurs, it can be fatal. Several treatments for colonic varices exist, including surgical, endoscopic, and endovascular treatments; however, management of colonic varices has not been standardized. For colonic varices, minimally invasive therapies would be desirable. Balloon-occluded retrograde transvenous obliteration (B-RTO) is one of the treatment options for colonic varices to prevent their rupture. Two cases of successful conventional B-RTO for these varices have already been reported. However, B-RTO using coil-assisted retrograde transvenous obliteration II (CARTO-II) procedure for these varices has not been reported.Case presentationA 71-year-old male patient had liver cirrhosis caused by hepatitis C virus infection. A varix was located at the ascending colon, which was coincidentally found on colonic endoscopy. Contrast-enhanced computed tomography (CT) showed that the feeder vein was the ileocolic vein and that the main draining vein was the right renal vein. Physicians concluded that treatment was required to avoid the risk of death from massive bleeding due to varix rupture. However, endoscopic and surgical treatments were difficult due to the anatomical location of the varix and the high risk of operative compilations, respectively. This ascending colonic varix was treated by balloon-occluded retrograde transvenous obliteration (B-RTO) using coil-assisted retrograde transvenous obliteration II (CARTO-II) procedure via the right renal vein. There were no complications during the procedure and no recurrences for 36 months during long-term follow-up.ConclusionsCARTO-II can be one of the effective treatment techniques for ascending colonic varices.
Highlights
Colonic varices are rare among ectopic varices
The varix did not recur or bleed during the 36-month follow-up. This is the first report of Balloon-occluded retrograde transvenous obliteration (B-RTO) using Coilassisted retrograde transvenous obliteration (CARTO)-II for an ascending colonic varix
B-RTO has been performed for various ectopic varices, such as duodenal, stomal, and small intestinal varices, as well as colonic varices (Watanabe et al 2010)
Summary
Colonic varices are rare among ectopic varices. A previous report demonstrated that once bleeding from colonic varices occurs, it can be fatal. Balloon-occluded retrograde transvenous obliteration (B-RTO) is one of the treatment options for colonic varices to prevent their rupture. B-RTO using coil-assisted retrograde transvenous obliteration II (CARTO-II) procedure for these varices has not been reported. Colonic varices are rare, accounting for 3.5% of all ectopic varices in a Japanese nationwide survey (Watanabe et al 2010). Bleeding from colonic varices is rare; the rate of their bleeding with liver cirrhosis is less than 9% (Hosking et al 1989). 14% of ectopic variceal bleeding occurs in the colon (Norton et al 1998). When ectopic variceal bleeding occurs, the mortality rate reaches as high as 32.1%, including death in 25.0% of cases with colonic varices (Watanabe et al 2010)
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