Intractable parastomal bleeding in a portal hypertensive patient managed by direct sclerotherapy: a case report

Patients with a stoma have a 5% developing parastomal varices chance, which tend to repetitive massive and life-threatening hemorrhages. Treatment of choice in parastomal varices have not been established, and Transjugular Intrahepatic Portosystemic Shunt (TIPS) has been revealed as the most successful measure.We report a hemodynamically unstable patient with the history of Ulcerative Colitis (UC) & Primary Sclerosing Cholangitis (PSC) with colostomy, because of colon cancer who presented with massive parastomal bleeding. Non-operative treatments and TIPS was failed to control the symptoms. Color Doppler ultrasound showed a hepato-fugal flow. The direct antegrade technique, using Sodium Tetradecyl Sulfate (STS 1%) and glue-Lipiodol, was applied under ultrasonography guidance, and complete stoppage of bleeding was achieved. No immediate or late complication or follow-up recurrence were noted after 2 month.In case of hepatofugal flow, direct percutaneous mesenteric parastomal venous access, and sclerotherapy is a rapid and relatively safe procedure for parastomal variceal bleeding.