A case report of the successful treatment by combined EVL and EIS following the evaluation of the hemodynamics of rectal varices using arterial portography

Abstract

A 75-year-old man has been followed up at our outpatient clinic for liver cirrhosis and hepatocellular carcinoma (HCC) caused by chronic hepatitis C virus infection. He had hematochezia found on March 2008, and subsequent colonoscopy identified the bleeding from rectal varices. In July 2008,he admitted to our hospital for the treatment of HCC. Portography via superior mesenteric and splenic artery was performed during the treatment, and no hepatofugal flow was detected. Instead, inferior mesenteric arterial portography revealed that inferior mesenteric artery feeded rectum, and visualized rectal varices, then outflow from inferior mesenteric vein to splenic vein as a drainage route. Thereafter we performed the combinational treatment with both endoscopic varices ligation (EVL) and endoscopic injection sclerotherapy (EIS).In details, we first operated EVL targeted the possible site for the out-wall flow of rectum at the oral edge of rectal varices, followed by the EIS under radiographical guidance. Subsequent contrast-enhanced CT confirmed the disappearance of the flow of the rectal varices. This case represented the successful treatment strategy of combined EVL and EIS following the evaluation of the hemodynamics of rectal varices using arterial portography. © 2010 The Japan Society of Hepatology.