Indian Journal of Urology
CASE REPORT
Year
: 2003  |  Volume : 20  |  Issue : 1  |  Page : 63--64

Recurrent and massive bleeding from ileal conduit peristomal varices: A case report


TB Yuvaraja, HB Tongaonkar 
 Department of Genitourinary Oncology, Tata Memorial Hospital, Mumbai, India

Correspondence Address:
H B Tongaonkar
Department of Genitourinary Oncology, Dr Ernest Borge«SQ»s Road, Tata Memorial Hospital, Parel, Mumbai - 400 012
India




How to cite this article:
Yuvaraja T B, Tongaonkar H B. Recurrent and massive bleeding from ileal conduit peristomal varices: A case report.Indian J Urol 2003;20:63-64


How to cite this URL:
Yuvaraja T B, Tongaonkar H B. Recurrent and massive bleeding from ileal conduit peristomal varices: A case report. Indian J Urol [serial online] 2003 [cited 2020 Jan 25 ];20:63-64
Available from: http://www.indianjurol.com/text.asp?2003/20/1/63/37130


Full Text

 Case Report



A 45-year-old man underwent preoperative radiotherapy followed by radical cystoprostatectomy and ileal conduit in 1986 for the treatment of invasive transitional cell car­cinoma of the urinary bladder. In October 1998 and March 1999 he had mild to moderate bleeding from the conduit and was treated in a local hospital. Again in February 2001 he experienced massive bleeding from the stoma and was referred to us. He had a history of recurrent episodes of mild to moderate bleeding from the stoma over the last one year. He was managed conservatively with blood trans­fusions and local pressure, and by cauterizing the bleed­ing vessels. Urine cytology, intravenous urography, ultrasonography, endoscopic examination of the ileal con­duit and random biopsy of the conduit mucosa excluded upper tract sites of bleeding and recurrent carcinoma. The bleeding vessels were located at the stomal margin and no other cause of bleeding could be identified. In September 2001 the patient came to the emergency room with brisk bleeding from the stomal site. Physical examination re­vealed splenomegaly and mild dilatation of veins in the peristomal region. Bleeding was controlled with cauteri­zation, suture ligation of the bleeding vessels and local pressure. Ultrasonogram done at this time showed liver cirrhosis with portal hypertension. Esophageal varices were seen on upper GI endoscopy. His hematocrit was 31% (n=37 to 47) and total bilirubin 1.6mg/dl (n=0.2 to 1.3). Other liver functions were normal. Doppler ultra­sound of the peristomal area confirmed multiple varices [Figure 1]. The patient was seropositive for Hepatitis C virus infection. He was managed with beta-blockers, which de­crease the portal hypertension. The patient is asympto­matic after one year of the treatment.

 Comments



Bleeding from stomal varices is a rare but well known complication in patients who have ileostomy, colostomy or ileal conduit and portal hypertension, and it may be life threatenting. [1],[2] Peristomal varices occur as a result of ve­nous communications at the mucocutaneous junction, be­tween the venous drainage of the bowel submucosa and the subcutaneous systemic venous plexus. Variceal tissue is friable and bleeding may arise spontaneously from ero­sion of a subcutaneous vein. Treatment of this often-se­vere hemorrhage is controversial. Conservative measures including simple local pressure, suture ligation and scle­rotherapy of the veins offer good local control but are as­sociated with high recurrence rates. Local portosystemic disconnection (mucocutaneous disconnection) has been done by some. Other options include transjugular intrahe­patic portasystemic shunting and open portasystemic­shunting procedures which have high success rates. [3]

References

1Bohm M. Grigoleit U. heal conduit bleeding in portal hypertension: A rare complication. Urology 2000 Jul; 39(4): 348-51.
2Chavez DR, Snyder PM, Juravsky LL Heaney JA. Recurrent ileal conduit hemorrhage in a elderly cirrhotic man. J Urol 1994 Sep:152(3) : 95 1-3.
3Medina CA. Caridi JG, Wajsman Z. Massive bleeding from ileal conduit peristomal varices: successful treatment with the transjugular intrahepatic portasystemic shunt. J Urol 1998 Jan; 159(1): 200-1.