PMC6106803_01
IV contrast-enhanced CT images of the abdomen and pelvic. (a) Large draining varix from the portal venous system (arrow). (b) Multiple varices within the right lower quadrant stoma (arrow).
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A review of intravenous contrast-enhanced CT imaging showed extensive venous varices around the stoma involving the abdominal wall with a large draining varix arising from the portal system, likely the inferior mesenteric vein [Figure 1].
Fluoroscopic images of right lower quadrant. (a) Contrast injection of the peristomal varix and opacification of the right iliac vein. (b) Opacification of the peristomal varices and the right iliac vein.
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Venography was performed and showed a large variceal collateral conglomerate around the stoma with variceal anastomosis with the right common femoral vein [Figure 2].
Fluoroscopic images of the right lower quadrant. (a) Venography after embolization with coils demonstrates hemostasis. (b) Subsequent venography after embolization with glue demonstrated sluggish flow in the portosystemic shunt with multiple filling defects within the visualized collaterals consistent with embolization. (c) Injection of the right femoral vein demonstrated flow from the right common femoral vein through the iliac system and IVC without opacification of the peristomal varices.
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Catheter position was confirmed with repeat venography, and multiple coils were deployed [Figure 3]. Postembolization venography showed sluggish flow in the draining varix with multiple filling defects within the visualized collaterals consistent with embolization [Figure 3]. There was no filling of the stomal variceal collaterals visualized [Figure 3].