A case of colonic varices complicated by alcoholic cirrhosis treated using balloon-occluded retrograde transvenous obliteration

Abstract

A 44-year-old man with cirrhosis arising from alcohol abuse manifested melena caused by the rupture of esophageal varices. He received endoscopic variceal ligation for the initial hemostasis, followed by endoscopic injection sclerotherapy as an additional consolidation therapy. A CT examination performed at the time of admission revealed collateral veins developing around the ascending colon, in which the feeding and draining vessels were identified as the superior mesenteric vein and the right testicular vein, respectively. Moreover, large nodular varices were observed in the ascending colon during a colonoscopy. To prevent the rupture of the colonic varices, balloon-occluded retrograde transvenous obliteration (B-RTO) was performed through the right testicular vein using a microballoon catheter. A CT examination performed 4 days after the B-RTO procedure revealed the disappearance of blood flow with thrombosis formation in both the colonic varices and the feeding vein. The varices in the ascending colon had completely disappeared when examined during a colonoscopy performed 4 months after the B-RTO procedure. B-RTO is a useful and minimally invasive procedure for the treatment of colonic varices to prevent bleeding.

Balloon-occluded retrograde transvenous obliteration of colonic varices: a case report

“…Management of ectopic varices was most common by observation (41.1%) and endoscopic methods of injection sclerotherapy and variceal ligation (29.2%), with 7.7% requiring surgery (Watanabe et al 2010). To the authors' knowledge, there are three reported cases of attempted BRTO for colonic varices, of which two were successful (Anan et al 2006;Matsumoto et al 2018;Ko et al 2013). Anan et al (Anan et al 2006) described the first successful BRTO of descending colonic varices, thereby obliterating the portosystemic shunt, for the treatment of hepatic encephalopathy.…”

“…Anan et al (Anan et al 2006) described the first successful BRTO of descending colonic varices, thereby obliterating the portosystemic shunt, for the treatment of hepatic encephalopathy. Matsumoto et al (Matsumoto et al 2018) reported the second successful case, obliterating ascending colonic varices through the right testicular vein, preventing variceal rupture. Ko et al (Ko et al 2013) reported a failed BRTO attempt in a 38-year-old female with variceal bleeding of the ascending colon, which was eventually treated by venous coil embolisation and histoacryl injection.…”

Usefulness of coil-assisted retrograde transvenous obliteration II (CARTO-II) for the treatment of ascending colonic varix: a case report

“…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). There have been only two reports of B-RTO for an ascending colonic varix (Matsumoto et al 2018;Liu et al 2020). In these reports, conventional B-RTO was performed via the right renal vein.…”

“…Balloon-occluded retrograde transvenous obliteration (B-RTO) is one of the treatment options for colonic varices and seems to be worth performing to prevent their rupture. Two cases of successful conventional B-RTO for ascending colonic varices have already been reported in the last 3 years (Matsumoto et al 2018;Liu et al 2020). However, to our knowledge, B-RTO using coil-assisted retrograde transvenous obliteration II (CARTO-II) procedure for colonic varices has not been reported.…”

Endoscopic band ligation for transverse colonic variceal bleeding: case report and review of the literature

“…6 Matsumoto et al performed balloon-occluded retrograde transvenous obliteration to prevent the rupture of an ascending colonic varix. 7 A transjugular intrahepatic portosystemic shunt, a vascular intervention for decreasing portal hypertension, was recently reported to cure the ascending colonic varices. 3,8 With the development of newer endoscopic instruments, more operative procedures will be performed by endoscopic therapy.…”