TY - JOUR T1 - Bleeding stomal varices: a marker of chronic liver disease JF - BMJ Case Reports DO - 10.1136/bcr.02.2009.1568 VL - 2009 SP - bcr0220091568 AU - Kethon Ainul Islam AU - Gareth Morris-Stiff Y1 - 2009/01/01 UR - http://casereports.bmj.com/content/2009/bcr.02.2009.1568.abstract N2 - 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. ER -