Portal hypertensive stomapathy: a newly described entity and its successful treatment by placement of a transjugular intrahepatic portosystemic shunt.
We report the case of a 68-yr-old woman who had previously undergone a total colectomy and ileostomy for Crohn's disease limited to the colon. She subsequently had recurrent episodes of severe stomal bleeding and was discovered to have micronodular cirrhosis. No definite stomal varices were seen by visual inspection, stomal endoscopy, stomal endosonography, or angiography. Nevertheless, multiple discrete, punctate bleeding pints were seen on the external mucosal surface of the stoma (not at the mucocutaneous junction). Despite undergoing numerous modes of treatment, the bleeding continued. The only successful and effective form of treatment was the placement of a transjugular intrahepatic portosystemic shunt.
Wong
R C
RC
Brigham and Women's Hospital, Division of Gastroenterology, Boston, Massachusetts, USA.
Berg
C L
CL
D000368:Aged; D000792:Angiography; D003082:Colectomy; D003424:Crohn Disease / Q000601:surgery; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000601:surgery; D007081:Ileostomy; D007413:Intestinal Mucosa / Q000000981:diagnostic imaging / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D012008:Recurrence; D014463:Ultrasonography