Treatment of Refractory Stomal Variceal Hemorrhage with Partial Splenic Artery Embolization: A Case Report

Abstract

In this report, we present the case of a patient with recurrent stomal variceal bleeding treated with partial splenic artery embolization (PSE). The patient, a woman in her 60s, had a history of liver cirrhosis and underwent ileocecal resection for ascending colon carcinoma 6 months earlier. The bleeding did not respond to local treatment. Balloon-occluded retrograde transvenous obliteration (BRTO) was performed via the right superficial epigastric vein. However, gross stomal variceal bleeding recurred 2 months post-BRTO. PSE was therefore performed and satisfactory results were obtained. To the best of our knowledge, this is the first case of recurrent hemorrhage from stomal varices that was successfully treated with PSE in a patient with portal hypertension. We consider PSE to be a minimally invasive and definitive treatment for recurrent stomal variceal bleeding.

A case of percutaneous transhepatic stomal varices embolization and partial splenic artery embolization for rectal cancer after CAPOX/BEV chemotherapy: the summary of the stomal varices related to oxaliplatin administration

“…We, therefore, also needed to address the portal hypertension. Splenectomy [ 38 , 39 ], PSE [ 40 ], transjugular intrahepatic portosystemic shunt (TIPS) [ 3 ], and surgical shunt angioplasty have been reported as treatments to reduce portal pressure. PSE is useful as a method to correct abnormal splenic hyperactivity and reduce portal pressure while preserving the important splenic functions [ 40 , 41 ].…”

“…For cases of macro-splenomegaly or a poor hepatic function, it is also important to embolize in fractions from the beginning (keeping the embolization area at 30% per embolization) [ 40 ]. Since PSE has a poor immediate effect on stoma variceal bleeding, it needs to be combined with local hemostatic management [ 39 ]. After PSE in the present patient, the platelet count improved, and chemotherapy was able to be restarted.…”