1995 Volume 56 Issue 1 Pages 131-134
A 68-year-old man, with a history of undergoing abdominoperineal resection of the rectum and sigmoidal colostomy for a rectal cancer 8 years before, was found to have bleeding stomal varices 2 years before. He was admitted to the hospital, because of repeated bleeding in spite of ostomy care.
The platelet count was 78, 000 and ICG 15min was 35.4%. CT scan showed splenomegaly and pooling of contrast medium around the colostomy stoma. Esophageal varices with RC sign was recognized on an upper gastrointestinal endoscopy. Angiography revealed an obstruction of the splenic vein, hepatofugal blood flow to the marginal vein of the colon, and a cluster of abnormal veins around the colostomy stoma. Upon laparotomy no chirrotic change was found in the liver. It was revealed that the varices were caused by left portal hypertension due to the obstruction of the splenic vein.
Splenectomy for the cut off of blood supply to the varices, division of the anastomotic vessels at mucocutaneous junction of colostomy, in addition to devascularization of the stomach and abdominal esophageal transection were carried out. Postoperative course was uneventful. Both stomal and esophageal varices disappeared and no bleeding occurred.
