PMC7069542_01
52 YO male with UC, PSC& colostomy due to colon cancer who presented with massive stomal bleeding. Arterio-portal phase CT SCAN shows parastomal varices (arrow) and enlarged mesenteric afferent tributary (arrowhead)
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F1
Ultrasound guide parastomal varicose vein puncture and contrast injection in inferomedial part of colostomy (mesenteric part) (arrowhead) and multiple afferent tiny subcutaneous systemic veins (arrows)
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F2
Color Doppler ultrasound indicated a hepato-fugal flow; a 22-gauge scalp vein was inserted under the ultrasonography guidance inferomedial part of the colostomy to the varices on the mesenteric side; in contrast, injected varices were presented to drain into multiple small subcutaneous veins, and eventually drained to the left iliofemoral junction (Figure 2).
Foam sclerotherapy of parastomal varices with slow injection and using negative air contrast to follow the foam, the afferent systemic veins were firs visualized (arrow). Due to LLQ manual compression and efferent obstruction, reflux to afferent mesenteric side is noted (arrowhead)
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F3
Next, we stopped injection (Figure 3A), and after that we injected 2CC of 70% glue-Lipiodol mixture (Figure 3B). 