Life-Threatening Bleeding from Peristomal Varices after Cystoprostatectomy: Multimodal Approach in a Cirrhotic, Encephalopathic Patient with Severe Portal Hypertension

Abstract EN

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.