P4201 - Peristomal Varices Causing GI Bleed

Ian Tobal, DO¹, James Gore, DO², Paula Cacioppo, MD², Ernest Philon, DO^1
1Ochsner Medical Center, Jefferson, LA; ²Ochsner Health Clinic Foundation, New Orleans, LA

Introduction: Peristomal varices are a rare but potentially life-threatening complication in patients with colostomies or ileostomies. These varices, characterized by dilated veins around the stoma, can lead to obscure gastrointestinal (GI) bleeding. We present a case of peristomal varices causing significant GI bleeding in a 52 year old male.

Case Description/Methods: A 52 year old male with a history of rectal cancer, cirrhosis, and colostomy presented to the hospital for acute blood loss anemia with bleeding from his colostomy site. Hemoglobin on presentation 8.1 (baseline of 9.3), with repeat 2 hours later at 5.7. Patient stepped up to ICU for hemorrhagic shock. EGD performed showed clean based gastric ulcer (Forrest Class III) and portal hypertensive gastropathy; no esophageal varices seen. Patient became hemodynamically stable with blood transfusions and an initial plan for follow up colonoscopy was made. However, following stepdown from ICU, patient had an episode of acute brisk bleeding from stoma site into his colostomy bag. CTA imaging showed no active bleed, but showed significant paristomal varices, suspected to be the source of bleeding. Interventional Radiology was consulted and performed a balloon occlusion anterograde variceal embolization of the bleeding peristomal varices. Patient stabilized after the procedure, with repeat Hemoglobin of 8.7, and was able to be discharged from the hospital 3 days later.

Discussion: Peristomal varices, though rare, can lead to substantial GI bleeding in patients with stomas. This case highlights the importance of recognizing peristomal varices as a potential cause of GI bleeding in patients with stomas. When these patients are being worked up for GI bleeding, and upper endoscopy is normal, this diagnosis should promptly be considered. Appropriate interventions, including endoscopic therapy, stoma revision, and embolization, are essential for managing this uncommon but potentially life-threatening complication.




Disclosures:


Ian Tobal, DO¹, James Gore, DO², Paula Cacioppo, MD², Ernest Philon, DO¹. P4201 - Peristomal Varices Causing GI Bleed, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.