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Digital subtraction venography via the transjugular intrahepatic portosystemic shunt (TIPS) shunt demonstrating the confluence of the inferior mesenteric vein into the splenic vein.
Source publication
We report a case of a 50-year-old man with a history of liver cirrhosis and colon cancer post end colostomy presenting to the emergency department with stomal bleeding and passage of clots into the colostomy bag. The patient was treated with transjugular intrahepatic portosystemic shunt (TIPS) and concomitant embolization of the stomal varices via...
Context in source publication
Context 1
... or portal hypertensive gastropathy. CT angiogram performed on admission showed prominent venous collaterals to the stoma (Figs. 5A-C and 6). The patient then underwent TIPS procedure for portal venous decompression and selective inferior mesenteric vein varix em- bolization using N-butyl cyanoacrylate (NBCA) mixed with ethiodol in April 2017 (Figs. 7-10). The inferior mesenteric vein varices were confined only to the sigmoid colon, which was the external portion of the ostomy. The patient was dis- charged from the hospital in stable condition a few days ...
Similar publications
Non-selective beta-blockers (NSBBs) are the mainstay of treatment for portal hypertension in the setting of liver cirrhosis. Randomised controlled trials demonstrated their efficacy in preventing initial variceal bleeding and subsequent rebleeding. Recent evidence indicates that NSBBs could prevent liver decompensation in patients with compensated...
Background:
Esophagogastric varices are a common complication of cirrhosis with portal hypertension and endoscopic treatment has been recognized as a primary preventive and therapeutic option for such patients; however, it should be noted that bradyarrhythmia is regarded as one of the contraindications to endoscopic examination. Meanwhile, acute v...
Purpose:
Although ultrasound has been widely used to evaluate transjugular intrahepatic portosystemic shunts (TIPS) patency, several studies have reported conflicting data regarding its performance. Therefore, we aimed to evaluate performance of ultrasound for detection of TIPS dysfunction by performing a meta-analysis.
Methods:
Literature searc...
Background and Aim
The model for end-stage liver disease (MELD) was originally developed to predict survival after transjugular intrahepatic portosystemic shunt (TIPS). The MELD-sodium (MELD-Na) score has replaced MELD for organ allocation for liver transplantation. However, there are limited studies to compare the MELD with MELD-Na to predict mort...
Background/aims:
In recent years, greater assessment accuracy after transjugular intrahepatic portosystemic shunt (TIPS) to ascertain prognosis has become important in decompensated cirrhosis due to portal hypertension. The aim of this study was to assess the ratio of the portal pressure gradient (PPG) pre-TIPS (pre-PPG) to albumin (PPA), which in...
Citations
... This reduction in mortality is caused by the availability of efficient options, such as upper GI endoscopy and EVBL, targeted pharmacological options, trans Jugular Intrahepatic Stent shunt (TIPS) and also with improvement of general measures. 5 There is always a risk of recurrence of upper GI bleed, which carries a mortality of 33%, so there must be some treatment to prevent further episodes of variceal bleed. Secondary prophylaxis includes drugs, repeated endoscopic procedures, or their combination and the use of shunts like TIPS. ...
Objective: To compare the efficacy of pharmacological and endoscopic procedures (band ligation) in preventing variceal bleed. Study Design: Randomized Control Trial. Setting: MU-I of Allied Hospital Faisalabad. Period: January to June 2020. Material & Methods: 80 patients were enrolled after fulfilling exclusion and inclusion criteria, divided into two groups. Group A, patients treated Carvedilol 6.25-12.5mg pulse rate of 60-70 beats per minute. Group B patients underwent repeated endoscopic procedures (band ligation), repeated every 2 weeks until obliteration of varices was achieved. Surveillance endoscopy was done one month later. Follow up was done by telephonic contact at 3 months. Results: In our study, mean age was 52.88+9.29 and 53.57+8.85 years in Group-A and B, 42.5%(n=17) in Group-A and 50%(n=20) in Group-B were male, 57.5%(n=23) in Group-A and 50%(n=20) female in group B, Recurrence of variceal bleeding and efficacy of drug comparison showed that 7.5%(n=3) in Group-A and 27.5%(n=11) in Group-B had a recurrence of variceal bleed while 92.5%(n=37) in Group-A and 72.5%(n=29) in Group-B had no recurrence of variceal bleed, p-value (0.01) was significant. Conclusion: Beta-blocker (Carvedilol) is more efficacious for preventing recurrence of variceal bleed than Endoscopic Band Ligation.
... e parastomal varices in this patient showed focal bleeding that was controlled by applying pressure using a cotton swab. Recent case reports have shown the use of percutaneous N-butyl-2-cyanoacrylate glue injection effectively stopped bleeding from parastomal varices [8]. However, injection of N-butyl-2-cyanoacrylate glue is not approved in the United States [1]. ...
... Despite being common in patients with a colostomy, many patients and physicians are unaware of parastomal varices and the frequency of bleeding [2,8]. Physicians are encouraged to remove any bandages or stoma appliance to examine the surrounding skin for a purplish hue around the stomal area, which suggests presence of parastomal varices [8]. ...
... Despite being common in patients with a colostomy, many patients and physicians are unaware of parastomal varices and the frequency of bleeding [2,8]. Physicians are encouraged to remove any bandages or stoma appliance to examine the surrounding skin for a purplish hue around the stomal area, which suggests presence of parastomal varices [8]. However, only 25% of patients exhibit the purplish hue; physicians are encouraged to use Doppler ultrasound, contrast-enhanced CT, and portal vein venography to confirm the diagnosis for many patients with recurrent bleeding around the stoma site [2]. ...
Gastrointestinal (GI) bleeding is a common problem in patients with portal hypertension. One of the most common causes of GI bleeding are varices (e.g., esophageal varices). In some instances, varices can develop between an intestinal stoma and the abdominal wall vasculature, known as parastomal varices. Specifically, parastomal varices are common in patients with a preexisting stoma and concurrent chronic portal hypertension. These patients often present with recurrent bleeding and may require regular transfusions. Herein, we report on a patient with parastomal varices and portal hypertension without hepatic cirrhosis. Given the high morbidity and mortality associated with surgical interventions, most clinical guidelines encourage observation and medical management of bleeding from parastomal varices. Among the nonsurgical interventions, manual compression and local maneuvers often successfully stop the bleeding. However, subsequent rebleeding from parastomal varices can remain a problem requiring additional treatment. Further research is needed to investigate appropriate medical or surgical alternatives for managing parastomal varices bleeding.
Gastrointestinal (GI) bleeding is a common complication of cirrhosis and portal hypertension. Most cases are secondary to gastro-esophageal variceal rupture, managed endoscopically1. Stomal bleeding is rare and there’s no standard therapy2. We present a case of a cirrhotic patient with recurrent stomal hemorrhage successfully treated with transjugular intrahepatic portosystemic shunt (TIPS) and stomal varices embolization.
Objective:
Correctly identifying and managing stomal and peristomal complications are key to assisting individuals with an ostomy when they are facing challenges with self-care. Providers that are knowledgeable and experienced with stomal and peristomal care are vital when complications arise. Providing care that is consistent with findings in current high evidence-based literature supports the goal of providing optimal patient outcomes in a timely manner. The objective of this study was to explore stomal and peristomal that presented in an outpatient ostomy clinic and compare these interventions with information found in the literature.
Method:
This retrospective study used a sample population of convenience that included adult patients aged ≥18 years who presented for stomal or peristomal complications in an outpatient ostomy clinic in northwest Ohio, US. Electronic medical records were reviewed to determine the presenting stomal or peristomal complication(s) of each patient and treatment was provided or prescribed. The interventions were then compared with information found in the literature. Length of treatment and reasons for referral to the surgeon that created the stoma were also reviewed.
Results:
This study showed that interventions for adult individuals with a stomal or peristomal complications that presented to the clinic were consistent with that found in the literature. This study also sought to deliver information to healthcare providers that may not be directly involved in ostomy care, helping to increase their understanding of problems that patients with an ostomy may experience.
Conclusion:
This study showed that interventions completed in this setting where the research took place was consistent with information found in literature.
Purpose of Review
To provide an overview of the classifications and clinical hallmarks of common cancer-related conditions that contribute to the high incidence of portal hypertension in this population and provide an update on currently available interventional radiology therapeutic approaches.
Recent Findings
In the last few decades, there have been significant advancements in understanding the pathophysiology of portal hypertension. This knowledge has led to the development of safer and more effective minimally invasive approaches. The main objective is to provide alternatives to prevent life-threatening complications from clinically significant portal hypertension and to allow the continuation of cancer treatment interventions that would otherwise be stopped.
Summary
Clinicians involved in cancer care should be aware of risk factors, associated complications, and management of portal hypertension in cancer patients. Interventional radiology offers minimally invasive alternatives that play a central role in improving clinical outcomes and survival of these patients, allowing the continuation of cancer treatments.
Rond het stoma van meneer Vos zijn varices zichtbaar. De spataderen hebben al verschillende keren gebloed, waardoor hij op de spoedeisende hulp terechtkwam. De eerste stap is nu: aanpassen van het stomamateriaal, maar meneer is gehecht aan zijn eendelig systeem.
Portal hypertension is a key pathophysiology of chronic liver diseases typified with cirrhosis or noncirrhotic portal hypertension. The development of collateral vessels is a characteristic feature of impaired portal hemodynamics. The paraumbilical vein (PUV), left gastric vein (LGV), posterior gastric vein (PGV), short gastric vein (SGV), splenorenal shunt (SRS), and inferior mesenteric vein (IMV) are major collaterals, and there are some rare collaterals. The degree and hemodynamics of collateral may affect the portal venous circulation and may compensate for the balance between inflow and outflow volume of the liver. Additionally, the development of collateral shows a relation with the liver function reserve and clinical manifestations such as esophageal varices (EV), gastric varices, rectal varices and the other ectopic varices, hepatic encephalopathy, and prognosis. Furthermore, there may be an interrelationship in the development between different collaterals, showing additional influences on the clinical presentations. Thus, the assessment of collaterals may enhance the understanding of the underlying pathophysiology of the condition of patients with portal hypertension. This review article concluded that each collateral has a specific function depending on the anatomy and hemodynamics and is linked with the relative clinical presentation in patients with portal hypertension. Imaging modalities may be essential for the detection, grading and evaluation of the role of collaterals and may help to understand the pathophysiology of the patient condition. Further investigation in a large-scale study would elucidate the basic and clinical significance of collaterals in patients with portal hypertension and may provide information on how to manage them to improve the prognosis as well as quality of life.
