[A case of rectal varices with recurrent hepatic encephalopathy successfully treated with percutaneous embolization].

Abstract

We report the case of an 81-year-old woman with a history of primary biliary cholangitis who had been hospitalized multiple times for hepatic encephalopathy. She presented with fresh bloody stools, and contrast-enhanced abdominal computed tomography (CT) revealed a dilated inferior mesenteric vein and varices protruding into the rectal lumen. A colonoscopy confirmed the presence of rectal varices (Rb), leading to a diagnosis of rectal variceal bleeding as the source of the hematochezia. Given her history of recurrent hepatic encephalopathy, percutaneous embolization was performed via a direct approach to the superior rectal vein to occlude the rectal varices and their feeding vessels. A follow-up colonoscopy performed 2 days after embolization showed that the rectal varices had decreased in size and had changed in color from red to blue. Contrast-enhanced CT conducted 5 days post-treatment demonstrated the disappearance of contrast enhancement in the rectal varices and thrombus formation leading to cessation of blood flow in the inferior mesenteric vein. The patient was subsequently discharged without further episodes of rectal variceal bleeding or recurrence of hepatic encephalopathy.