PMC5852303_01
Sigmoidoscopy showing large rectal varices before the balloon-occluded antegrade transvenous obliteration (BATO) procedure.
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F1
The procedure was aborted because the varices were too large for ligation (Figure 1).
Ultrasound showing percutaneous transhepatic access of the right portal vein (red arrow) with antegrade flow down the inferior mesenteric vein (white arrow) and superior rectal vein.
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F2
Under ultrasound guidance, the right portal vein was accessed percutaneously and portography demonstrated antegrade flow down the inferior mesenteric vein and superior rectal vein (Figure 2).
Ultrasound showing 20 mL sclerosing foam instilled through a microcatheter into the rectal varices (arrow).
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F3
Sclerosing treatment foam (20 mL) was instilled through a microcatheter into the rectal varices (Figure 3).
Ultrasound showing coil embolization of proximal superior rectal vein post-sclerotherapy.
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F4
We elected to perform coil embolization of the proximal superior rectal vein to ensure no washout (Figure 4).
Sigmoidoscopy 6 months after BATO showing eradicated rectal varices.
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F5
At the 6-month follow-up, the patient had no recurrent rectal bleeding, and sigmoidoscopy confirmed variceal eradication (Figure 5).