title: Percutaneous Transhepatic Embolization of Bleeding Rectal Varices Using A New Embolic And Sclerotic Mixture Augmented By Amplatzer Vascular Plug 2.
abstract: We report a case of 59-year-old female with non-alcoholic-steato-hepatitis (NASH) induced cirrhosis, who presented with hematochezia. The patient had a history of bleeding esophageal varices treated with endoscopic variceal ligation (EVL). Colonoscopy showed large rectal varices which were the source of her lower gastrointestinal bleeding (LGIB). Since endoscopic treatment for LGIB are limited, and because the patient had portal vein thrombosis which contraindicated transjugular intrahepatic portosystemic shunt (TIPS), we performed percutaneous transhepatic embolization of her rectal varices using a new mixture of embolic and sclerotic agents, followed by Amplatzer plug 2 (AVP 2). To our knowledge, the use of this new mixture with the AVP 2 in the rectal varices treatment has not been previously published in literature. Our case provides an alternative treatment modality that can be used for rectal varices treatment, when TIPS and endoscopic management fails or is contraindicated.
authors.affiliation: Department of Radiology, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA; Department of Radiology, Cairo University, Cairo, Egypt.
authors.forename: Ahmed Kamel
authors.initials: AK
authors.lastname: Abdel-Aal
authors.affiliation: Department of Radiology, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA.
authors.forename: Nabila
authors.initials: N
authors.lastname: Dawoud
authors.affiliation: Department of Radiology, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA; Department of Radiology, Zagazig University, Zagazig, Egypt.
authors.forename: Amr Soliman
authors.initials: AS
authors.lastname: Moustafa
authors.affiliation: Department of Family medicine, University of Alabama, Tuscaloosa, Alabama, USA.
authors.forename: Maysoon F
authors.initials: MF
authors.lastname: Hamed
authors.affiliation: Department of Radiology, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA.
authors.forename: Souheil
authors.initials: S
authors.lastname: Saddekni
mesh_terms: D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D012002:Rectal Diseases / Q000000981:diagnostic imaging* / Q000628:therapy*; D012007:Rectum / Q000098:blood supply*; D012597:Sclerosing Solutions; D055989:Septal Occluder Device; D014648:Varicose Veins / Q000000981:diagnostic imaging* / Q000628:therapy*
chemical_list: D003287:Contrast Media; D012597:Sclerosing Solutions
keywords: Avitine; Rectal varices; Sotradecol; amplatzer vascular plug; embolization; portal hypertension