title: Life-threatening bleeding from peristomal varices after cystoprostatectomy: multimodal approach in a cirrhotic, encephalopathic patient with severe portal hypertension.
abstract: The bleeding of peristomal varices due to a portosystemic shunt is rare but potentially life-threatening in cirrhotic patients with portal hypertension. The scarce case reports in the literature recommend transjugular intrahepatic portosystemic shunt (TIPS) to prevent further bleeding. We report on a 72-year-old man who was referred to our hospital because of life-threatening bleeding from peristomal varices, three years after radical cystoprostatectomy for invasive bladder cancer. CT imaging showed liver cirrhosis with a prominent portosystemic shunt leading to massively enlarged peristomal varices. TIPS was taken into consideration, but not possible due to hepatic encephalopathy (HE). Medical therapy with lactulose and the nonselective beta-blocker carvedilol was initiated to treat HE and portal hypertension. In a second step, the portosystemic shunt was percutaneously embolized. Here, we present a multimodal approach to treat intractable bleeding from peristomal varices in a patient with ileal conduit urinary diversion, not suitable for TIPS.
authors.affiliation: Department of Urology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland.
authors.forename: Sergej E L
authors.initials: SE
authors.lastname: Staubli
authors.affiliation: Department of Urology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Gramann
authors.affiliation: Department of Urology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schwab
authors.affiliation: Department of Gastroenterology and Hepatology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Semela
authors.affiliation: Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland.
authors.forename: Lukas
authors.initials: L
authors.lastname: Hechelhammer
authors.affiliation: Department of Urology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Engeler
authors.affiliation: Department of Urology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland.
authors.forename: Hans-Peter
authors.identifier: 0000-0001-7892-9766
authors.initials: HP
authors.lastname: Schmid
authors.affiliation: Department of Urology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland.
authors.forename: Dominik
authors.initials: D
authors.lastname: Abt
authors.affiliation: Department of Urology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland.
authors.forename: Livio
authors.initials: L
authors.lastname: Mordasini