Transjugular intrahepatic portosystemic shunt for treatment of bleeding ectopic varices with portal hypertension.
OBJECTIVE
In the setting of hepatic failure and portal hypertension, hemorrhage from stomal and rectal varices is a well-described problem. It has recently been suggested that transjugular intrahepatic portosystemic shunting may be useful in the therapy of bleeding from parastomal or anorectal varices in patients unresponsive to conservative therapy.


METHODS
We retrospectively review our institution's experience of five patients with parastomal varices and seven patients with anorectal varices who underwent transjugular intrahepatic portosystemic shunting for hemorrhage refractory to conservative management between 1994 and 1998.


RESULTS
The study group consisted of four Child's A, five Child's B, and three Child's C patients. The mean age of the patients was 60.3 (range, 37-85) years. Mean follow-up was 15 (range, 5-27) months. The mean portosystemic pressure gradient before transjugular intrahepatic portosystemic shunting was 17.4+/-3.1 mm Hg. After transjugular intrahepatic portosystemic shunting, the mean portosystemic pressure gradient was reduced to 5.8+/-1.8 mm Hg (P<0.05). Transjugular intrahepatic portosystemic shunting were successful in complete resolution of bleeding in all patients. Three patients had encephalopathic changes after transjugular intrahepatic portosystemic shunting. Two patients died within 30 days of transjugular intrahepatic portosystemic shunting of causes unrelated to the procedure. Four patients required shunt revision within one year of placement.


CONCLUSIONS
The transjugular intrahepatic portosystemic shunting procedure is an effective modality in the therapy of cirrhotic patients with bleeding stomal or anorectal varices unresponsive to conservative management. There is an acceptable procedure-related morbidity and mortality.
Shibata
D
D
Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Brophy
D P
DP
Gordon
F D
FD
Anastopoulos
H T
HT
Sentovich
S M
SM
Bleday
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000098:blood supply; D003125:Colostomy; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000601:surgery*; D006484:Hemorrhoids / Q000601:surgery*; D006501:Hepatic Encephalopathy / Q000209:etiology; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D007081:Ileostomy; D007082:Ileum / Q000098:blood supply; D008103:Liver Cirrhosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012007:Rectum / Q000098:blood supply; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D014648:Varicose Veins / Q000601:surgery*