Recurrent haemorrhage from peristomal varices after Bricker diversion: case report and review of the literature.

Peristomal varices can occur in patients with gastrointestinal or urinary d iversions associated with portal hypertension. It is now no longer rare to propose radical surgery for invasive bladder tumours in patients also suffe ring from hepatic cirrhosis. responsible for specific subsequent complicati ons. Less than ten cases of varicose haemorrhages have been described on il eal bladders. The authors report the case of a patient,with cirrhosis (Chil d B) treated surgically (radical cystoprostatectomy and Bricker transileal cutaneous diversion) for invasive bladder tumour Episodes of bleeding varic es occurred two months after surgery Repeated and abundant haemorrhage led to the placement of an intrahepatic shunt (TIPS) allowing reduction of the portal hypertension and the severity of the bleeding. When local control of the bleeding is no longer possible. reduction of the portosystemic pressur e gradient is required. TIPS is an effective alternative to surgical shunts , responsible for high morbidity and mortality in these debilitated patient s.