title: TIPSS in the treatment of ectopic variceal bleeding.
abstract: OBJECTIVE
  Bleeding from ectopic varices is a well recognized life-threatening complication of portal hypertension but the optimal treatment of this problem is yet to be established.
  
  
  METHODS
  We retrospectively reviewed patients with ectopic variceal bleeding who underwent transjugular intrahepatic portosystemic shunting for recurrent bleeding not responding to conservative management.
  
  
  RESULTS
  Over an eleven-year period we identified ten patients who underwent TIPSS for ectopic variceal hemorrhage. Six patients bled from rectal varices and four from stomal varices. TIPSS was successful in nine patients. The Childs-Pugh grade of the patients was A=3, B=3 and C=4. The follow-up period ranged from 7 days to 1380 days. Rebleeding occurred in three patients, two of whom died. The remaining patient had a blocked TIPSS and successfully underwent repeat stenting which re-established patency. Four patients (Childs B=2, Childs C=2) died within 60 days. All three patients with Childs A liver disease were alive at one year.
  
  
  CONCLUSIONS
  TIPSS can be used effectively to treat ectopic variceal bleeding. Patients with Childs grade A liver disease appear to do well with TIPSS. Those with advanced liver disease (Childs B & C) have a uniformly poor outcome. In these patients ectopic variceal hemorrhage is likely to represent a terminal event.
authors.affiliation: Department of Gastroenterology, Royal Liverpool University Hospital Liverpool, L7 8XP, UK. nayarmanu@hotmail.com
authors.forename: M
authors.initials: M
authors.lastname: Nayar
authors.forename: R
authors.initials: R
authors.lastname: Saravanan
authors.forename: P C
authors.initials: PC
authors.lastname: Rowlands
authors.forename: R G
authors.initials: RG
authors.lastname: McWilliams
authors.forename: J
authors.initials: J
authors.lastname: Evans
authors.forename: R J
authors.initials: RJ
authors.lastname: Sutton
authors.forename: I T
authors.initials: IT
authors.lastname: Gilmore
authors.forename: H L
authors.initials: HL
authors.lastname: Smart
authors.forename: M G
authors.initials: MG
authors.lastname: Lombard
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006470:Hemorrhage / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D008108:Liver Diseases, Alcoholic / Q000150:complications; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012007:Rectum / Q000098:blood supply*; D054047:Surgical Stomas / Q000098:blood supply*; D016896:Treatment Outcome; D014648:Varicose Veins / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*