Purpose: Results: A 69 year old man has a history of Ulcerative Colitis with total abdominal colectomy with ileostomy performed Febuary 2002 due to treatment refractory disease. He presented four years later with presumed lower GI bleed with bright red blood noted in his ostomy bag. Ileoscopy performed at that time showed normal ileal mucosa, while careful inspection of the ileostomy site showed continued oozing from an external source. Upper endoscopy was performed to assess other signs of portal hypertension showing mild gastropathy and small esophageal varices. Non-selective beta-blocker therapy was initiated at that time with a diagnosis of Laennec's Cirrhosis. A diagnosis of peristomal varices was made after confirmation on review of abdominal imaging. Recurrent bleeding continued to require hospitalization and transfusion on three separate presentations leading to initial TIPSS procedure as well as revision bringing porto-systemic pressure gradient from 15 mmHg to 4 mmHg. He was placed prophylactically on lactulose at that time, but progressive difficulties required the addition of rifaximin. Despite the TIPSS procedure, he continued to have episodes of bleeding from his peristomal varices requiring transfusion. Conservative measures were initially employed in attempts to control bleeding after repeat porto-systemic pressure gradient measurement confirmed a widely patent TIPSS. Application of silver nitrate, oversewing with suture, and injection sclerotherapy were all attempted in addition to direct pressure without durable result. After initial consultation with Colorectal Surgery, his ostomy was taken down and re-sited for definitive therapy of his recurrent peristomal variceal hemorrhage. In the 13 months since revision of his ileostomy, he has had far fewer difficulties with bleeding only requiring transfusion on two occasions. Conclusion: Peristomal variceal bleeding is difficult to control and can be a life-threatening complication of portal hypertension in patients with colonic resection requiring ileostomy. In patients with advanced liver disease as defined by Childs Classification, ectopic variceal bleeding frequently represents a terminal event. Stoma revision with devascularization has been found in previous reports to be temporarily effective in reducing recurrent peristomal variceal bleeding and has reduced the need for transfusion in our patient. Liver transplantation remains the only potential therapy for our patient at this time, but given his age and comorbid medical status it has been determined that he is not a candidate.