Skip to main content
PMC home page
Gut logoLink to Gut
. 1996 Jun;38(6):932–935. doi: 10.1136/gut.38.6.932

Bleeding anorectal varices: successful treatment with transjugular intrahepatic portosystemic shunting (TIPS).

A C Fantin 1, G Zala 1, B Risti 1, J F Debatin 1, W Schöpke 1, C Meyenberger 1
PMCID: PMC1383205  PMID: 8984036

Abstract

A patient with severe recurrent rectal bleeding from anorectal varices due to portal hypertension because of hepatitis C virus related liver cirrhosis is presented. As illustrated by the report, it is essential to differentiate bleeding anorectal varices from bleeding haemorrhoids because treatment is different. In our patient, implantation of a transjugular intrahepatic portosystemic shunt (TIPS) led to an impressive regression of the anorectal varices, which could be demonstrated by sigmoidoscopy, endosonography, and magnetic resonance imaging. Recurrent rectal bleeding in a patient with portal hypertension should alert the physician to consider anorectal varices. Endoscopic ultra-sound and magnetic resonance imaging are new and non-invasive modalities for diagnosis and post-treatment control.

Full text

PDF
932

Images in this article

932Figure 1
on p.932
933Figure 2
on p.933
933Figure 3
on p.933
933Figure 4
on p.933
934Figure 5
on p.934
934Figure 6
on p.934

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Chawla Y. K., Dilawari J. B. Anorectal varices, haemorrhoids, and portal hypertension. Lancet. 1989 Apr 1;1(8640):725–725. doi: 10.1016/s0140-6736(89)92238-1. [DOI] [PubMed] [Google Scholar]
  2. Colapinto R. F., Stronell R. D., Birch S. J., Langer B., Blendis L. M., Greig P. D., Gilas T. Creation of an intrahepatic portosystemic shunt with a Grüntzig balloon catheter. Can Med Assoc J. 1982 Feb 1;126(3):267–268. [PMC free article] [PubMed] [Google Scholar]
  3. Giovannini M., Seitz J. F. Endoscopic ultrasonography with a linear-type echoendoscope in the evaluation of 94 patients with pancreatobiliary disease. Endoscopy. 1994 Sep;26(7):579–585. doi: 10.1055/s-2007-1009043. [DOI] [PubMed] [Google Scholar]
  4. Goenka M. K., Kochhar R., Nagi B., Mehta S. K. Rectosigmoid varices and other mucosal changes in patients with portal hypertension. Am J Gastroenterol. 1991 Sep;86(9):1185–1189. [PubMed] [Google Scholar]
  5. Hamlyn A. N., Morris J. S., Lunzer M. R., Puritz H., Dick R. Portal hypertension with varices in unusual sites. Lancet. 1974 Dec 28;2(7896):1531–1534. doi: 10.1016/s0140-6736(74)90283-9. [DOI] [PubMed] [Google Scholar]
  6. Herman B. E., Baum S., Denobile J., Volpe R. J. Massive bleeding from rectal varices. Am J Gastroenterol. 1993 Jun;88(6):939–942. [PubMed] [Google Scholar]
  7. Hosking S. W., Johnson A. G. Bleeding anorectal varices--a misunderstood condition. Surgery. 1988 Jul;104(1):70–73. [PubMed] [Google Scholar]
  8. Hosking S. W., Smart H. L., Johnson A. G., Triger D. R. Anorectal varices, haemorrhoids, and portal hypertension. Lancet. 1989 Feb 18;1(8634):349–352. doi: 10.1016/s0140-6736(89)91724-8. [DOI] [PubMed] [Google Scholar]
  9. Hsieh J. S., Huang C. J., Huang Y. S., Huang T. J. Demonstration of rectal varices by transhepatic inferior mesenteric venography. Dis Colon Rectum. 1986 Jul;29(7):459–461. doi: 10.1007/BF02561586. [DOI] [PubMed] [Google Scholar]
  10. Jin G., Rikkers L. F. Cause and management of upper gastrointestinal bleeding after distal splenorenal shunt. Surgery. 1992 Oct;112(4):719–727. [PubMed] [Google Scholar]
  11. Katz J. A., Rubin R. A., Cope C., Holland G., Brass C. A. Recurrent bleeding from anorectal varices: successful treatment with a transjugular intrahepatic portosystemic shunt. Am J Gastroenterol. 1993 Jul;88(7):1104–1107. [PubMed] [Google Scholar]
  12. Keane R. M., Britton D. C. Massive bleeding from rectal varices following repeated injection sclerotherapy of oesophageal varices. Br J Surg. 1986 Feb;73(2):120–120. doi: 10.1002/bjs.1800730214. [DOI] [PubMed] [Google Scholar]
  13. Killi M. R., Ozütemiz O., Sevinc E. Transrectal ultrasonographic demonstration of rectal varices. Am J Gastroenterol. 1992 Nov;87(11):1685–1686. [PubMed] [Google Scholar]
  14. LaBerge J. M., Ring E. J., Gordon R. L., Lake J. R., Doherty M. M., Somberg K. A., Roberts J. P., Ascher N. L. Creation of transjugular intrahepatic portosystemic shunts with the wallstent endoprosthesis: results in 100 patients. Radiology. 1993 May;187(2):413–420. doi: 10.1148/radiology.187.2.8475283. [DOI] [PubMed] [Google Scholar]
  15. Lee S. H. Case report: transrectal ultrasound in the diagnosis of ano-rectal varices. Clin Radiol. 1994 Jan;49(1):69–70. doi: 10.1016/s0009-9260(05)82921-6. [DOI] [PubMed] [Google Scholar]
  16. Lemon S. M. Immunologic approaches to assessing the response to inactivated hepatitis A vaccine. J Hepatol. 1993;18 (Suppl 2):S15–S19. doi: 10.1016/s0168-8278(05)80372-1. [DOI] [PubMed] [Google Scholar]
  17. McCormack T. T., Bailey H. R., Simms J. M., Johnson A. G. Rectal varices are not piles. Br J Surg. 1984 Feb;71(2):163–163. doi: 10.1002/bjs.1800710236. [DOI] [PubMed] [Google Scholar]
  18. Richon J., Berclaz R., Schneider P. A., Marti M. C. Sclerotherapy of rectal varices. Int J Colorectal Dis. 1988 Jun;3(2):132–134. doi: 10.1007/BF01645319. [DOI] [PubMed] [Google Scholar]
  19. Rössle M., Haag K., Ochs A., Sellinger M., Nöldge G., Perarnau J. M., Berger E., Blum U., Gabelmann A., Hauenstein K. The transjugular intrahepatic portosystemic stent-shunt procedure for variceal bleeding. N Engl J Med. 1994 Jan 20;330(3):165–171. doi: 10.1056/NEJM199401203300303. [DOI] [PubMed] [Google Scholar]
  20. Wang M., Desigan G., Dunn D. Endoscopic sclerotherapy for bleeding rectal varices: a case report. Am J Gastroenterol. 1985 Oct;80(10):779–780. [PubMed] [Google Scholar]
  21. Waxman J. S., Tarkin N., Dave P., Waxman M. Fatal hemorrhage from rectal varices. Report of two cases. Dis Colon Rectum. 1984 Nov;27(11):749–750. doi: 10.1007/BF02554608. [DOI] [PubMed] [Google Scholar]
  22. Weinshel E., Chen W., Falkenstein D. B., Kessler R., Raicht R. F. Hemorrhoids or rectal varices: defining the cause of massive rectal hemorrhage in patients with portal hypertension. Gastroenterology. 1986 Mar;90(3):744–747. doi: 10.1016/0016-5085(86)91132-7. [DOI] [PubMed] [Google Scholar]
  23. Weiserbs D. B., Zfass A. M., Messmer J. Control of massive hemorrhage from rectal varices with sclerotherapy. Gastrointest Endosc. 1986 Dec;32(6):419–421. doi: 10.1016/s0016-5107(86)71928-7. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES