Journal of Investigative Medicine High Impact Case Reports (Jan 2020)

A Novel Approach for Management of Bleeding Stomal Varices: A Case Report of Ultrasound-Guided Percutaneous Sclerotherapy

  • Dustin Uhlenhopp DO,
  • Kristin Olson DO,
  • Tagore Sunkara MD

DOI
https://doi.org/10.1177/2324709620904569
Journal volume & issue
Vol. 8

Abstract

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Ileostomy variceal bleeds can be a serious complication in patients with cirrhosis and ileostomy but make up a small portion of total variceal bleeds. Multiple modalities have been described as therapeutic options for stomal variceal bleeding, but an optimal intervention has yet to be established. We present a case of a 51-year-old patient with preserved ejection fraction heart failure, hepatitis C cirrhosis, recent esophageal varices banding, and colectomy with ileostomy who developed bleeding ileostomy varices that were effectively treated under direct ultrasound-guided percutaneous injection of sodium tetradecyl sulfate to the feeding superior mesenteric venous flow. The patient did not have a recurrence of bleeding at 7-month follow-up. We consider direct ultrasound-guided percutaneous injection of sodium tetradecyl sulfate of acute bleeding stomal varices to be safe and effective in decompensated cirrhotic patients.