title: Ectopic variceal bleeding from colonic stoma: two case reports.
abstract: Parastomal variceal bleeding is a rare complication of portal hypertension, which often occurs in a recurrent manner and might be life-threatening in extreme situations. Treatment options vary, and no standard therapy has been established. Herein, we report 2 such cases. The first patient suffered from parastomal variceal bleeding after Hartmann procedure for rectal cancer. Stomal revision was performed, but bleeding recurred 1 month later. The second patient developed the disease after Miles procedure for rectal cancer. Embolization via the percutaneous transhepatic approach was performed using the Onyx liquid embolic system (LES) (Micro Therapeutics Inc, dba ev3 Neurovascular) in combination with coils, and satisfactory results were obtained after a 4-month follow-up. Our cases illustrate that surgical revision should be used with caution as a temporary solution due to the high risk of rebleeding, whereas transhepatic embolization via the Onyx LES and coils could be considered a safe and effective choice for skillful managers.
authors.affiliation: From the Peking University Wu-Jieping Urology Center (LW), Peking University Shougang Hospital, Peking University Health Science Center; Department of General Surgery (J-lZ, G-nZ, J-yL, YX, H-zQ); and Department of Interventional Radiology (NY), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.forename: Jiao-Lin
authors.initials: JL
authors.lastname: Zhou
authors.forename: Ning
authors.initials: N
authors.lastname: Yang
authors.forename: Guan-Nan
authors.initials: GN
authors.lastname: Zhang
authors.forename: Jun-Yang
authors.initials: JY
authors.lastname: Lu
authors.forename: Yi
authors.initials: Y
authors.lastname: Xiao
authors.forename: Hui-Zhong
authors.initials: HZ
authors.lastname: Qiu
mesh_terms: D000368:Aged; D001803:Blood Transfusion / Q000379:methods; D003082:Colectomy / Q000379:methods; D003125:Colostomy / Q000009:adverse effects / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis; D008297:Male; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy; D012004:Rectal Neoplasms / Q000150:complications / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D054047:Surgical Stomas / Q000098:blood supply*; D016896:Treatment Outcome; D014648:Varicose Veins / Q000209:etiology / Q000503:physiopathology / Q000628:therapy