Role of interventional radiology in intractable bleeding rectal varices
- PDF / 1,159,165 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 100 Downloads / 205 Views
REVIEW
Role of interventional radiology in intractable bleeding rectal varices Amir Ata Rhanemai‑Azar1 · Maharshi Rajdev1 · Mayada Ismail2 · Eric Dean McLoney1 · Sidhartha Tavri1 · Mohammed S. Al‑Natour1 Received: 1 May 2020 / Revised: 21 August 2020 / Accepted: 3 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract In the setting of portal hypertension, intractable bleeding from anorectal varices is a rare occurrence. In this review, clinical presentation and management of this dilemma are presented in a case-based fashion. Bleeding may occur in the absence of prior history of cirrhosis or gastroesophageal varices and measurement of hepatic venous pressure gradient and liver biopsy could help to establish the diagnosis. Successful treatment outcome necessitates tailoring treatment to the patient’s anatomy and imaging findings. A multidisciplinary algorithmic approach is also proposed to aid clinicians in this regard. Keywords Transjugular intrahepatic portosystemic shunt · Anorectal variceal bleeding · Interventional radiology
Introduction Anorectal varices are relatively common in patients with portal hypertension (PHT); however, intractable, life-threatening bleeding is a rare occurrence [1, 2]. Interventional radiology procedures have a well-established role in the management of patients with PHT and gastrointestinal bleeding, particularly when other treatment procedures fail or are contraindicated. These procedures not only help to confirm the diagnosis by measuring the transhepatic portosystemic gradient, but also provide many of the treatment options for related complications of cirrhosis such as variceal bleeding or ascites [3]. Transjugular intrahepatic portosystemic shunt (TIPS) placement has become a common treatment option for many complications of PHT, after it was shown to be as effective as surgical side-to-side portocaval shunts with lower morbidity and mortality [4]. Nevertheless, further research is needed for many of the other indications for TIPS, as currently there is a lack of large-scale randomized controlled trials. To date, only case reports have discussed
* Mohammed S. Al‑Natour [email protected] 1
Department of Radiology, University Hospitals, Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA
Department of Medicine, University Hospitals, Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
2
the role of TIPS placement in controlling intractable bleeding from rectal varices in patients with cirrhosis [2]. Yet, careful deliberation is required before the decision is made for TIPS placement, as there are several situations that this procedure may not control the bleeding or even lead to lifethreatening complications and early mortality [5]. In this review, clinical presentation, diagnosis, and management of patients with intractable rectal bleeding are presented in a case-based fashion.
Case 1 A 54-year-old male with a past medical history (PMH) of chronic
Data Loading...
