Chronic gastrointestinal bleeding from ileal varices after total proctocolectomy for ulcerative colitis: correction by mesocaval shunt.
This report describes a 48-yr-old woman who had undergone proctocolectomy and ileostomy for ulcerative colitis. Subsequently, numerous episodes of bleeding via the ileostomy occurred during a 24-mo period. Despite numerous procedures, including upper gastrointestinal endoscopy, ileoscopy. celiac and superior mesenteric arteriography, and exploratory laparatomy, a bleeding site was not identified. However, a detailed arteriographic examination with special venous phase studies clearly demonstrated ileal varices. A mesocaval shunt resulted in a marked reduction in portal pressure, and the patient had experienced no recurrent bleeding over a 24-mo period. The importance of obtaining appropriate venous phase studies during arteriography is emphasized because it is critical in establishing the correct diagnosis.
D000792:Angiography; D002908:Chronic Disease; D003082:Colectomy / Q000009:adverse effects*; D003093:Colitis, Ulcerative / Q000601:surgery; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects; D007082:Ileum / Q000098:blood supply* / Q000000981:diagnostic imaging; D008642:Mesenteric Veins / Q000601:surgery*; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D011184:Postoperative Period; D013997:Time Factors; D014648:Varicose Veins / Q000209:etiology*; D014683:Vena Cava, Superior / Q000601:surgery*