A patient with portal hypertension may develop varices at a stoma site. These varices can be a source of significant bleeding.
Reasons that bleeding stomal varices may be missed:
(1) the possibility of portal hypertension is not considered
(2) the ostomy site is not examined without the appliance
(3) Doppler ultrasonography is not performed
Conservative management may include:
(1) local pressure
(2) vessel ligation
(3) recumbent position
(4) topical epinephrine
(5) beta-blocker
(6) octreotide
More definitive management for recurrent or persistent bleeding:
(1) embolization
(2) transjugular intrahepatic portocaval shunt (TIPS)
(3) surgical shunting
(4) liver transplantation (if the MELD >= 15)
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Specialty: Gastroenterology
ICD-10: ,
