The ileal stoma and protal hypertension: an uncommon site of variceal bleeding

M. A. Adson and R. E. Fulton

Patients who have chronic ulcerative colitis coexisting with liver disease and portal hypertension may suffer hemorrhagic parastomal varices after proctocolectomy and ileostomy. Large portal systemic collateral vessels between the superior mesenteric venous tributaries and the abdominal wall can be demonstrated by portal venography. Hemorrhage occurs from the mucocutaneous junction, a vulnerable point in this collateral circuit. Management by major and minor stomal revisions has been unsuccessful. Three patients who have bled from stomal and from esophagogastric varices were treated with portasystemic shunts. None of the three has had recurrent bleeding or postshunt encephalopathy during the 19 to 27 months after these operations.