Reminder of important clinical lesson
Bleeding stomal varices: a marker of chronic liver disease
1 Royal Devon and Exeter Foundation Trust, Department of Plastic Surgery, RD&E (Wonford) Hospital, Barrack Road, Exeter, Devon, EX2 5DW, UK
2 North Glamorgan NHS Trust, Department of General Surgery, Prince Charles Hospital, Merthyr Tydfil, CF47 9DT, UK
Correspondence to:
Kethon Ainul Islam, kethon{at}hotmail.com
A 44-year-old man presented with acute onset painless haemorrhage from his ileostomy. He had undergone panproctocolectomy for ulcerative colitis 17 years previously. Immediately following admission, he experienced further massive haemorrhage, developing hypovolaemic shock. Active resuscitation including suturing of a bleeding stomal varix was successful. An ultrasound scan of the liver was reported to be normal and the patient was discharged for further outpatient investigation. However he reattended 8 days later with further significant haemorrhage. Investigation with CT revealed portal hypertension and cirrhosis. The patient is currently awaiting a transjugular intrahepatic portosystemic shunt (TIPS) procedure and transjugular biopsy to alleviate his portal hypertension and yield a tissue sample for histological diagnosis. The case highlights the need for clinicians to have a high index of suspicion when presented with bleeding stomas. Further investigation is warranted and may reveal significant underlying hepatic disease. Additionally, further procedures may be necessitated to prevent recurrence of haemorrhage.
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