Massive Peristomal Bleeding – How to Act?

Abstract

Peristomal varices are rare ectopic varices in chronic liver disease. They develop at the enterocutaneous junction of a stoma and represent a portosystemic venous shunt between the portal circulation and venous systemic circulation of the abdominal wall. Peristomal varices are hardly visible on clinical examination and are not accessible on endoscopic evaluation, therefore their diagnosis generally only surge after the first bleeding episode. In most severe cases, variceal bleeding can quickly progress to hypovolemic shock, with an estimated mortality rate of 3 to 4% per hemorrhagic episode. Recent clinical reviews do not define the standard of care, due to the small number of cases described. In this article, we present a case of massive peristomal varices hemorrhage successfully treated by transhepatic percutaneous endovascular embolization.