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  • Title: The role of minimally invasive percutaneous embolisation technique in the management of bleeding stomal varices.
    Author: Kwok AC, Wang F, Maher R, Harrington T, Gananadha S, Hugh TJ, Samra JS.
    Journal: J Gastrointest Surg; 2013 Jul; 17(7):1327-30. PubMed ID: 23546560.
    Abstract:
    INTRODUCTION: Stomal varices can develop in patients with ostomy in the setting of portal hypertension. Bleeding from the stomal varices is uncommon, but the consequences can be disastrous. Haemorrhage control measures that have been described in the literature include pressure dressings, stomal revision, mucocutaneous disconnection, variceal suture ligation and sclerotherapy. These methods may only serve to temporise the stomal bleeding and have a high risk of recurrent bleed. While transjugular intrahepatic porto-systemic shunting has been advocated as the treatment of choice in patients with underlying liver cirrhosis, histoacryl glue or coil embolisation has been successfully employed in patients who are not suitable candidates for TIPS. METHODS AND RESULTS: Direct percutaneous embolisation of the dominant varices was performed successfully under ultrasound and fluoroscopic guidance in two patients using a combination of coils and histoacryl glue. RESULTS: While transjugular intrahepatic porto-systemic shunting has been advocated as the treatment of choice in patients with underlying liver cirrhosis, histoacryl glue or coil embolisation has been successfully employed in patients who are not suitable candidates for TIPS. CONCLUSION: Direct percutaneous embolisation is a safe and effective treatment for stomal varices in selected patients.
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