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Les complications chirurgicales en urologie adulte : chirurgie de la vessie. Prog Urol 2022; 32:940-952. [DOI: 10.1016/j.purol.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/20/2022]
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2
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Ectopic Stomal Varices in Chronic Liver Disease. ACG Case Rep J 2022; 9:e00751. [PMID: 35359750 PMCID: PMC8963858 DOI: 10.14309/crj.0000000000000751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
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Kaczmarek DJ, Kupczyk P, Schultheiß M, Chang J, Jansen C, Trebicka J, Weismüller T, Vilz TO, Luu AM, Attenberger U, Strassburg CP, Meyer C, Praktiknjo M. TIPS for the management of stomal variceal bleeding due to cirrhotic and non-cirrhotic portal hypertension. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 60:753-760. [PMID: 34741298 DOI: 10.1055/a-1508-6446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Portal hypertension (PH) is associated with the development of esophageal or gastric varices, which can cause bleedings with high mortality. Varices can also manifest at sites of stomata. These parastomal varices can cause recurrent variceal bleedings (VB) despite local therapies. We present a case series of parastomal VB due to PH that were managed with implantation of transjugular intrahepatic portosystemic shunt (TIPS). METHODS We retrospectively included all patients (pt) from 2 tertiary medical centers with parastomal VB between January 2014 and February 2020 who underwent the TIPS procedure. RESULTS Nine pt were included. Seven pt had liver cirrhosis, mostly alcohol-related. Two pt had non-cirrhotic PH due to porto-sinusoidal vascular disease (PSD). Four pt had a colostomy, 1 an ileostomy, and 4 an ileal conduit. Malignancy was the leading cause of stoma surgery. All 9 pt suffered from recurrent parastomal VB despite non-selective beta-blocker and/or local therapy (e.g., compression, coagulation, suture ligation, or surgical stoma revision). All pt received TIPS implantation. In 7 pt, TIPS implantation led to sustainable hemostasis. Two pt suffered a bleeding relapse that was attributable to TIPS dysfunction. TIPS revision with coil embolization of the varices terminated the VB sustainably in both pt. CONCLUSIONS In pt presenting with recurrent stomal bleedings, parastomal varices as a rare complication of PH must be taken into consideration as an underlying cause. In our case series, we managed to sustainably cease parastomal VB by TIPS implantation with or without coil embolization of the ectopic varices.
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Affiliation(s)
| | - Patrick Kupczyk
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | | | - Johannes Chang
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Christian Jansen
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Jonel Trebicka
- Medizinische Klinik 1, University of Frankfurt, Frankfurt am Main, Germany
| | - Tobias Weismüller
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Tim Oliver Vilz
- Department of Surgery, University Hospital Bonn, Bonn, Germany
| | - Andreas Minh Luu
- St. Josef Hospital, Department of Surgery, Ruhr University Bochum, Bochum, Germany
| | | | | | - Carsten Meyer
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Michael Praktiknjo
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
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Kim J, Randhawa H, Sands D, Lambe S, Puglia M, Serrano PE, Pinthus JH. Muscle-Invasive Bladder Cancer in Patients with Liver Cirrhosis: A Review of Pertinent Considerations. Bladder Cancer 2021; 7:261-278. [PMID: 38993608 PMCID: PMC11181825 DOI: 10.3233/blc-211536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/09/2021] [Indexed: 11/15/2022]
Abstract
The incidence of liver cirrhosis is increasing worldwide. Patients with cirrhosis are generally at a higher risk of harbouring hepatic and non-hepatic malignancies, including bladder cancer, likely due to the presence of related risk factors such as smoking. Cirrhosis can complicate both the operative and non-surgical management of bladder cancer. For example, cirrhotic patients undergoing abdominal surgery generally demonstrate worse postoperative outcomes, and chemotherapy in patients with cirrhosis often requires dose reduction due to its direct hepatotoxic effects and reduced hepatic clearance. Multiple other considerations in the peri-operative management for cirrhosis patients with muscle-invasive bladder cancer must be taken into account to optimize outcomes in these patients. Unfortunately, the current literature specifically related to the treatment of cirrhotic bladder cancer patients remains sparse. We aim to review the literature on treatment considerations for this patient population with respect to perioperative, surgical, and adjuvant management.
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Affiliation(s)
- John Kim
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - David Sands
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Shahid Lambe
- Division of Urology, McMaster University, Hamilton, ON, Canada
- McMaster Institute of Urology, St. Joseph’s Hospital, Hamilton, ON, Canada
| | - Marco Puglia
- Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada
| | | | - Jehonathan H. Pinthus
- Division of Urology, McMaster University, Hamilton, ON, Canada
- Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada
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5
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Gowda SN, Sethi P, Motapothula U. Peristomal variceal hemorrhage at the ileal conduit site due to extrahepatic portosystemic shunt. Indian J Urol 2020; 36:130-132. [PMID: 32549665 PMCID: PMC7279101 DOI: 10.4103/iju.iju_292_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/11/2020] [Accepted: 01/18/2020] [Indexed: 12/14/2022] Open
Abstract
Peristomal variceal bleeding is a rare but known complication with portal hypertension. In patients with recurrent peristomal hemorrhage, atypical varices should be considered, and liver cirrhosis should be excluded even with normal liver function tests. We report a case of a 76-year-old male who presented with recurrent ileal conduit site peristomal hemorrhage without known chronic liver disease. His liver function tests were normal, but computed tomography of the abdomen and pelvis showed liver nodularity and peristomal varices. He was diagnosed to have cirrhosis with portal hypertension and further tested positive for active hepatitis C infection. The patient's extrahepatic portosystemic ileal conduit site shunt was successfully treated with transjugular intrahepatic portosystemic shunt and endovascular variceal coiling. This case identifies a situation where it is imperative to identify occult liver cirrhosis with portosystemic shunt as a cause of ileal conduit site recurrent stomal bleeding.
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Affiliation(s)
- Smitha Narayana Gowda
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, SD 57108, USA
| | - Prince Sethi
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, SD 57108, USA
| | - Uma Motapothula
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, SD 57108, USA
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6
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Kupczyk PA, Fischer S, Praktiknjo M, Stein J, Müller SC, Meyer C. [Life-threatening bleeding from ileal conduit venous varices in a patient with portal hypertension]. Urologe A 2018; 58:41-44. [PMID: 30539203 DOI: 10.1007/s00120-018-0824-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Life-threatening bleeding from portosystemic varices is a feared complication of portal hypertension. Particularly, varices in atypical locations-so-called ectopic varices-pose a challenge for diagnosis and therapy. In the present article, we describe the case of a patient with liver cirrhosis and recurrent bleeding from an ileal conduit resulting from peristomal varicosis. The difficult and hence delayed diagnosis led to a life-threatening hemorrhage that was successfully treated with interventional radiological variceal embolization and TIPS (transjugular intrahepatic portosystemic shunt) implantation.
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Affiliation(s)
- P A Kupczyk
- Radiologische Klinik, Universitätsklinikum Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Deutschland.
| | - S Fischer
- Radiologische Klinik, Universitätsklinikum Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Deutschland
| | - M Praktiknjo
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn, Bonn, Deutschland
| | - J Stein
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - S C Müller
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - C Meyer
- Radiologische Klinik, Universitätsklinikum Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Deutschland
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Young S, Wong J, Rosenberg M, Golzarian J, Frank N. Treatment of peristomal hemorrhage: A review of outcomes and comparison of two minimally invasive techniques. Diagn Interv Imaging 2018; 99:793-799. [DOI: 10.1016/j.diii.2018.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/28/2018] [Accepted: 08/31/2018] [Indexed: 02/06/2023]
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Kim J, Lee D, Oh K, Lee M, So S, Yang DH, Kim CW, Gwon DI, Chung YH. [Surgical Removal of Migrated Coil after Embolization of Jejunal Variceal Bleeding: A Case Report]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 69:74-78. [PMID: 28135795 DOI: 10.4166/kjg.2017.69.1.74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Jejunal variceal bleeding is less common compared with esophagogastric varices in patients with portal hypertension. However, jejunal variceal bleeding can be fatal without treatment. Treatments include surgery, transjugular intrahepatic porto-systemic shunt (TIPS), endoscopic sclerotherapy, percutaneous coil embolization, and balloon-occluded retrograde transvenous obliteration (BRTO). Percutaneous coil embolization can be considered as an alternative treatment option for those where endoscopic sclerotherapy, surgery, TIPS or BRTO are not possible. Complications of percutaneous coil embolization have been reported, including coil migration. Herein, we report a case of migration of the coil into the jejunal lumen after percutaneous coil embolization for jejunal variceal bleeding. The migrated coil was successfully removed using surgery.
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Affiliation(s)
- Junhwan Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Danbi Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyunghwan Oh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mingee Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seol So
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hoon Yang
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chan Wook Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Il Gwon
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hwa Chung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Life-threatening bleeding from peristomal varices after cystoprostatectomy: multimodal approach in a cirrhotic, encephalopathic patient with severe portal hypertension. Case Rep Urol 2015; 2015:785010. [PMID: 25709851 PMCID: PMC4325549 DOI: 10.1155/2015/785010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 01/16/2015] [Indexed: 12/19/2022] Open
Abstract
The bleeding of peristomal varices due to a portosystemic shunt is rare but potentially life-threatening in cirrhotic patients with portal hypertension. The scarce case reports in the literature recommend transjugular intrahepatic portosystemic shunt (TIPS) to prevent further bleeding. We report on a 72-year-old man who was referred to our hospital because of life-threatening bleeding from peristomal varices, three years after radical cystoprostatectomy for invasive bladder cancer. CT imaging showed liver cirrhosis with a prominent portosystemic shunt leading to massively enlarged peristomal varices. TIPS was taken into consideration, but not possible due to hepatic encephalopathy (HE). Medical therapy with lactulose and the nonselective beta-blocker carvedilol was initiated to treat HE and portal hypertension. In a second step, the portosystemic shunt was percutaneously embolized. Here, we present a multimodal approach to treat intractable bleeding from peristomal varices in a patient with ileal conduit urinary diversion, not suitable for TIPS.
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Wang L, Zhou JL, Yang N, Zhang GN, Lu JY, Xiao Y, Qiu HZ. Ectopic variceal bleeding from colonic stoma: two case reports. Medicine (Baltimore) 2015; 94:e406. [PMID: 25590847 PMCID: PMC4602545 DOI: 10.1097/md.0000000000000406] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Parastomal variceal bleeding is a rare complication of portal hypertension, which often occurs in a recurrent manner and might be life-threatening in extreme situations. Treatment options vary, and no standard therapy has been established. Herein, we report 2 such cases. The first patient suffered from parastomal variceal bleeding after Hartmann procedure for rectal cancer. Stomal revision was performed, but bleeding recurred 1 month later. The second patient developed the disease after Miles procedure for rectal cancer. Embolization via the percutaneous transhepatic approach was performed using the Onyx liquid embolic system (LES) (Micro Therapeutics Inc, dba ev3 Neurovascular) in combination with coils, and satisfactory results were obtained after a 4-month follow-up. Our cases illustrate that surgical revision should be used with caution as a temporary solution due to the high risk of rebleeding, whereas transhepatic embolization via the Onyx LES and coils could be considered a safe and effective choice for skillful managers.
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Affiliation(s)
- Lei Wang
- From the Peking University Wu-Jieping Urology Center (LW), Peking University Shougang Hospital, Peking University Health Science Center; Department of General Surgery (J-lZ, G-nZ, J-yL, YX, H-zQ); and Department of Interventional Radiology (NY), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Management of parastomal varices: who re-bleeds and who does not? A systematic review of the literature. Tech Coloproctol 2012; 17:163-70. [DOI: 10.1007/s10151-012-0922-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Accepted: 10/08/2012] [Indexed: 02/06/2023]
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12
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Mitach A, Goris Gbenou M, Rashed S, Allegre JP, Ladhib Z, Lopez JG. [Secondary recurrent haemorrhage with peristomal varices complicating a urinary derivation according to Bricker and treated efficiently by endoscopic way]. Prog Urol 2012; 22:127-31. [PMID: 22284598 DOI: 10.1016/j.purol.2011.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Revised: 04/17/2011] [Accepted: 04/26/2011] [Indexed: 10/18/2022]
Abstract
Stomal varices developed in patients with cirrhosis and enterostomy can be source of important haemorrhages. It is a rare event but often recurrent and difficult enough to treat efficiently. In certain cases, consequences can be severe. We report the case of a 63-years-old patient with medical history of hepatic cirrhosis who underwent a radical cystoprostatectomy with urinary derivation type Bricker. Five years afterwards, he developed stomal varices very haemorrhagic treated efficiently by endoscopic way, without any recurrence 12 months later. This observation shows that stomal haemorrhages can be treated by endoscopic way.
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Affiliation(s)
- A Mitach
- Service d'urologie, centre hospitalier de Valence, 179, boulevard Maréchal-Juin, 26000 Valence, France.
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Naidu SG, Castle EP, Kriegshauser JS, Huettl EA. Direct percutaneous embolization of bleeding stomal varices. Cardiovasc Intervent Radiol 2009; 33:201-4. [PMID: 19283430 DOI: 10.1007/s00270-009-9536-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 01/06/2009] [Accepted: 01/28/2009] [Indexed: 12/14/2022]
Abstract
Stomal variceal bleeding can develop in patients with underlying cirrhosis and portal hypertension. Most patients are best treated with transjugular intrahepatic portosystemic shunt (TIPS) creation because this addresses the underlying problem of portal hypertension. However, some patients are not good candidates for TIPS creation because they have end-stage liver disease or encephalopathy. We describe such a patient who presented with recurrent bleeding stomal varices, which was successfully treated with percutaneous coil embolization. The patient had bleeding-free survival for 1 month before death from unrelated causes.
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Affiliation(s)
- Sailen G Naidu
- Department of Radiology, Division of Interventional Radiology, Mayo Clinic Arizona, Mayo Clinic Hospital, Phoenix, AZ 85054, USA.
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Islam KA, Morris-Stiff G. Bleeding stomal varices: a marker of chronic liver disease. BMJ Case Rep 2009; 2009:bcr02.2009.1568. [PMID: 21686988 DOI: 10.1136/bcr.02.2009.1568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
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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Affiliation(s)
- Kethon Ainul Islam
- Royal Devon and Exeter Foundation Trust, Department of Plastic Surgery, RD&E (Wonford) Hospital, Barrack Road, Exeter, Devon, EX2 5DW, UK
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Gross hematuria from an ileal conduit as a first presentation of portal hypertension. ACTA ACUST UNITED AC 2008; 5:569-73. [DOI: 10.1038/ncpuro1192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2008] [Accepted: 07/01/2008] [Indexed: 11/08/2022]
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Spier BJ, Fayyad AA, Lucey MR, Johnson EA, Wojtowycz M, Rikkers L, Harms BA, Reichelderfer M. Bleeding stomal varices: case series and systematic review of the literature. Clin Gastroenterol Hepatol 2008; 6:346-52. [PMID: 18328439 DOI: 10.1016/j.cgh.2007.12.047] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Bleeding stomal varices are a common problem in patients with surgical stomas and portal hypertension, and remain difficult to diagnose and manage. METHODS We identified all patients at our institution with bleeding stomal varices from 1989 to 2004. We surveyed all patients undergoing ileal pouch-anal anastomosis from 1997 to 2007 for bleeding anastomotic varices. Finally, we performed a systematic review of the literature focusing on diagnosis and treatment of bleeding stomal varices that included 74 English language studies of 234 patients. RESULTS We identified 8 patients with bleeding stomal varices. Recognition of stomal varices typically was delayed, particularly when failing to examine the ostomy without the appliance. Stomal variceal bleeding was confirmed by Doppler ultrasound or angiographic imaging. Simple local therapy usually stopped bleeding, albeit temporarily. Sclerotherapy was effective, but at the expense of unacceptable stomal damage. Decompressive therapy was required for secondary prophylaxis, including transjugular intravascular transhepatic shunts (2 patients), surgical portosystemic shunts (2 patients), and liver transplantation (1 patient). No patient with an ileal pouch-anal anastomosis developed anastomotic bleeding from varices. CONCLUSIONS Primary prevention of bleeding stomal varices requires avoidance of creating enterocutaneous stomas in patients with portal hypertension. Careful inspection of the uncovered ostomy is essential for bleeding stomal varices diagnosis. Once identified, conservative measures will stop bleeding temporarily with definitive therapy required, including transjugular intravascular transhepatic shunts, surgical shunts, or liver transplantation.
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Affiliation(s)
- Bret J Spier
- Section of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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