RECURRENT BLEEDING FROM COLON VARICES IN PORTAL-HYPERTENSION - SUCCESSFUL PREVENTION OF RECURRENCES BY IMPLANTATION OF A TRANSJUGULARLY INTRODUCED INTRAHEPATIC STENT-SHUNT (TIPS)

History and clinical findings: Sclerotherapy was performed in a 52-yea r-old patient with alcoholic Liver cirrhosis (Child-Pugh stage A) for recurrent bleeding from oesophageal varices. Half a year later he agai n was admitted to hospital because of recurrent passage of bloody stoo ls. The cardiovascular status was stable; the liver was enlarged by 15 cm in the medioclavicular line. Investigations: Endoscopy revealed se veral varices in the colon near the right flexure. One of the varices had an ulcer of 5 mm size. Duplex sonography revealed portal hypertens ion with cirrhosis of the liver and partial thrombosis of the main tru nk of the portal vein without any sign of cavernous transformation. Tr eatment and course: Because of the partial portal vein thrombosis it w as decided to insert a transjugular intrahepatic portosystemic stent s hunt. This obviated the thrombosis and lowered the portosystemic press ure gradient by 68%. With the shunt functioning well there were no fur ther bleedings in the subsequent year. Conclusion: The only slightly i nvasive TIPS implantation is an effective therapeutic procedure for bl eeding from colon varices caused by portal hypertension.