Transjugular intrahepatic portosystemic shunt for treatment of bleeding ectopic varices with portal hypertension

PURPOSE: In the setting of hepatic failure and portal hypertension, hemorrh age from stomal and rectal varices is a well-described problem. It has rece ntly been suggested that transjugular intrahepatic portosystemic shunting m ay be useful in the therapy of bleeding from parastomal or anorectal varice s in patients unresponsive to conservative therapy. METHODS: We retrospecti vely review our institution's experience of five patients with parastomal v arices and seven patients with anorectal varices who underwent transjugular intrahepatic portosystemic shunting for hemorrhage refractory to conservat ive management between 1994 and 1998. RESULTS: The study group consisted of four Child's A, five Child's B, and three Child's C patients. The mean age of the patients was 60.3 (range, 37-85) years. Mean follow-up was 15 (rang e, 5-27) months. The mean portosystemic pressure gradient before transjugul ar intrahepatic portosystemic shunting was 17.4 +/- 3.1 mmHg. After transju gular intrahepatic portosystemic shunting, the mean portosystemic pressure gradient was reduced to 5.8 +/- 1.8 mmHg (P < 0.05). Transjugular intrahepa tic portosystemic shunting were successful in complete resolution of bleedi ng in all patients. Three patients had encephalopathic changes after transj ugular intrahepatic portosystemic shunting. Two patients died within 30 day s of transjugular intrahepatic portosystemic shunting of causes unrelated t o the procedure. Four patients required shunt revision within one year of p lacement. CONCLUSION: The transjugular intrahepatic portosystemic shunting procedure is an effective modality in the therapy of cirrhotic patients wit h bleeding stomal or anorectal varices unresponsive to conservative managem ent. There is an acceptable procedure-related morbidity and mortality.