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CASE REPORT |
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| Year : 2003 | Volume
: 20
| Issue : 1 | Page : 63-64 |
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Recurrent and massive bleeding from ileal conduit peristomal varices: A case report
TB Yuvaraja, HB Tongaonkar
Department of Genitourinary Oncology, Tata Memorial Hospital, Mumbai, India
Correspondence Address:
H B Tongaonkar
Department of Genitourinary Oncology, Dr Ernest Borge's Road, Tata Memorial Hospital, Parel, Mumbai - 400 012
India
 Source of Support: None, Conflict of Interest: None  | Check |
Keywords: Portasystemic shunt, liver cirrhosis, varices.
How to cite this article:
Yuvaraja T B, Tongaonkar H B. Recurrent and massive bleeding from ileal conduit peristomal varices: A case report. Indian J Urol 2003;20:63-4 |
 Case Report | |  |
A 45-year-old man underwent preoperative radiotherapy followed by radical cystoprostatectomy and ileal conduit in 1986 for the treatment of invasive transitional cell carcinoma of the urinary bladder. In October 1998 and March 1999 he had mild to moderate bleeding from the conduit and was treated in a local hospital. Again in February 2001 he experienced massive bleeding from the stoma and was referred to us. He had a history of recurrent episodes of mild to moderate bleeding from the stoma over the last one year. He was managed conservatively with blood transfusions and local pressure, and by cauterizing the bleeding vessels. Urine cytology, intravenous urography, ultrasonography, endoscopic examination of the ileal conduit and random biopsy of the conduit mucosa excluded upper tract sites of bleeding and recurrent carcinoma. The bleeding vessels were located at the stomal margin and no other cause of bleeding could be identified. In September 2001 the patient came to the emergency room with brisk bleeding from the stomal site. Physical examination revealed splenomegaly and mild dilatation of veins in the peristomal region. Bleeding was controlled with cauterization, suture ligation of the bleeding vessels and local pressure. Ultrasonogram done at this time showed liver cirrhosis with portal hypertension. Esophageal varices were seen on upper GI endoscopy. His hematocrit was 31% (n=37 to 47) and total bilirubin 1.6mg/dl (n=0.2 to 1.3). Other liver functions were normal. Doppler ultrasound of the peristomal area confirmed multiple varices [Figure - 1]. The patient was seropositive for Hepatitis C virus infection. He was managed with beta-blockers, which decrease the portal hypertension. The patient is asymptomatic after one year of the treatment.
| Comments | | |
Bleeding from stomal varices is a rare but well known complication in patients who have ileostomy, colostomy or ileal conduit and portal hypertension, and it may be life threatenting. [1],[2] Peristomal varices occur as a result of venous communications at the mucocutaneous junction, between the venous drainage of the bowel submucosa and the subcutaneous systemic venous plexus. Variceal tissue is friable and bleeding may arise spontaneously from erosion of a subcutaneous vein. Treatment of this often-severe hemorrhage is controversial. Conservative measures including simple local pressure, suture ligation and sclerotherapy of the veins offer good local control but are associated with high recurrence rates. Local portosystemic disconnection (mucocutaneous disconnection) has been done by some. Other options include transjugular intrahepatic portasystemic shunting and open portasystemicshunting procedures which have high success rates. [3]
| References | | |
| 1. | Bohm M. Grigoleit U. heal conduit bleeding in portal hypertension: A rare complication. Urology 2000 Jul; 39(4): 348-51.  |
| 2. | Chavez DR, Snyder PM, Juravsky LL Heaney JA. Recurrent ileal conduit hemorrhage in a elderly cirrhotic man. J Urol 1994 Sep:152(3) : 95 1-3. |
| 3. | Medina CA. Caridi JG, Wajsman Z. Massive bleeding from ileal conduit peristomal varices: successful treatment with the transjugular intrahepatic portasystemic shunt. J Urol 1998 Jan; 159(1): 200-1. |
[Figure - 1]
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