Journal Mobile Options
Table of Contents
Vol. 64, No. 4, 2001
Issue release date: 2001

The Long-Term Efficacy of the Intrahepatic Portosystemic Shunt (TIPS) for the Treatment of Bleeding Anorectal Varices in Cirrhosis

A Case Report and Review of the Literature

Ory G. · Spahr L. · Megevand J.-M. · Becker C. · Hadengue A.
To view the fulltext, log in and/or choose pay-per-view option

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Background: In patients with portal hypertension and variceal hemorrhage, the transjugular intrahepatic portosystemic shunt (TIPS) is indicated when drug therapy or endoscopic treatment fails to control bleeding. Ruptured esophageal or gastric varices are the most frequent causes of portal hypertension-related hemorrhage, but anorectal varices may also bleed. Although several case reports have proposed TIPS in this situation, the long-term results of this procedure have not been described. Methods: We report here the case of a 68-year-old patient with decompensated cirrhosis who presented with recurrent hematochezia due to anorectal varices. Results: A successful control of bleeding could be obtained after placement of TIPS. After 3 years of follow-up, rectal bleeding did not recur, the shunt remained primarily patent, and the patient did not present overt hepatic encephalopathy. Conclusion: TIPS procedure should be considered as an effective treatment of recurrent bleeding from anorectal varices in patients with decompensated cirrhosis.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Spahr L, Fenyves D, N’Guyen VV, Roy L, Legault L, Dufresne MP, Pomier-Layrargues G: Improvement of hepatorenal syndrome by transjugular intrahepatic portosystemic shunt. Am J Gastroenterol 1995;90:1169–1172.

    External Resources

  2. Norton ID, Andrews JC, Kamath PS: Management of ectopic varices. Hepatology 1998;28:1154–1158.
  3. Haskal ZJ, Scott M, Rubin RA, Cope C: Intestinal varices: Treatment with the transjugular intrahepatic portosystemic shunt. Radiology 1994;191:183–187.
  4. Shibata D, Brophy DP, Gordon FD, Anastopoulos HT, Sentovich SM, Bleday R: Transjugular intrahepatic portosystemic shunt for treatment of bleeding ectopic varices with portal hypertension. Dis Colon Rectum 1999;42:1581–1585.
  5. Herman BE, Baum S, Denobile J, Volpe RJ: Massive bleeding from rectal varices. Am J Gastroenterol 1993;88:939–942.
  6. Hosking SW, Johnson AG, Smart HL, Triger DR: Anorectal varices, hemorrhoids and portal hypertension. Lancet 1989;i:349–352.
  7. Johansen K, Bardin J, Orloff MJ: Massive bleeding from hemorrhoidal varices in portal hypertension. JAMA 1980;244:2084–2085.
  8. Waxman JS, Tarkin N, Dave P, Waxman M: Fatal hemorrhage from rectal varices: Report of two cases. Dis Colon Rectum 1984;27:749–750.

    External Resources

  9. Wang M, Designa G, Dunn D: Endoscopic sclerotherapy for bleeding rectal varices: A case report. Am J Gastroenterol 1985;80:779–780.

    External Resources

  10. Levine J, Tahiri A, Banerjee B: Endoscopic ligation of bleeding rectal varices. Gastrointest Endosc 1993;39:188–190.
  11. Yeh T, McGuire HH: Intractable bleeding from anorectal varices relieved by inferior mesenteric vein ligation. Gastroenterology 1994;107:1165–1167.
  12. Demirel H, Pieterman H, Lameris JS, Van Buurren HR: Transjugular embolization of the inferior mesenteric vein for bleeding anorectal varices after unsuccessful transjugular intrahepatic portosystemic shunt. Am J Gastroenterol 1997;92:1226–1227.
  13. Weinshal E, Chen W, Falkenstein DB, Kessler R, Raicht RF: Hemorrhoids or rectal varices: Defining the cause of massive rectal hemorrhage in patients with portal hypertension. Gastroenterology 1986;90:744–747.

    External Resources

  14. Warren WD, Millikan WJ, Henderson JM, Wright L, Kutner M, Smith RB, Fulenwider JT, Salam AA, Galambos JT: Ten years of portal hypertensive surgery at Emory: Results and new perspectives. Ann Surg 1982;195:530–542.

    External Resources

  15. Harrison CA, Benner KG, Sahagun G: Ectopic variceal hemorrhage managed by TIPS. Hepatology 1992;116:304–309.
  16. Katz JA, Rubin RA, Cope C, Holland G, Brass CA: Recurrent bleeding from anorectal varices: Successful treatment with a transjugular intrahepatic portosystemic shunt. Am J Gastroenterol 1993;88:1104–1107.
  17. Godil A, McCracken JD: Rectal variceal bleeding treated by transjugular intrahepatic portosystemic shunt: Potential and pitfalls. J Clin Gastroenterol 1997;25:460–462.
  18. Fantin AC, Zala G, Risti B, Debatin JF, Schopke W, Meyenberger C: Bleeding anorectal varices: Successful treatment with transjugular intrahepatic portosystemic shunt (TIPS). Gut 1996;38:932–935.
  19. Uemoto S, Martin AJ, Fleming W, Habib NA: The use of transjugular intrahepatic portosystemic shunt and surgical portocaval H-shunt for the treatment of colorectal variceal bleeding. Hepatogastroenterology 1995;42:557–560.

    External Resources

  20. Burroughs AK, Patch D: Transjugular intrahepatic portosystemic shunt. Semin Liver Dis 1999;19:457–473.
  21. Pomier-Layrargues G, Villeneuve JP, Deschênes M, Bui B, Perreault P, Fenyves D, Willems B, Marleau D, Bilodeau M, Lafortune M, Dufresne MP: Transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic variceal ligation in the prevention of variceal rebleeding in patients with cirrhosis: A randomized trial. Gut 2001;48:390–396.


Pay-per-View Options
Direct payment This item at the regular price: USD 33.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 23.00