Management of colostomal hemorrhage resulting from portal hypertension

Diseases of the Colon and Rectum
W Z GoldsteinR Crystal

Abstract

Colostomy and ileostomy stomal hemorrhage is a rare and potentially fatal complication of portal hypertension. We describe two patients with colostomy stomal hemorrhage who had both undergone abdominoperineal resection for carcinoma of the rectosigmoid colon. Patient 1, in the absence of metastatic disease with minimal to moderate functional hepatic impairment, undersent a mesocaval interposition graft shunt and had no recurrence of stomal hemorrhage during the four-month postoperative period. Patient 2, in the presence of metastatic disease to the lungs and liver, was not shunted and died of hepatic and renal failure. Angiography, in particular splenoportography, is extremely helpful in establishing the diagnosis of portal hypertension and planning appropriate operative procedure. We reviewed the literature on ileostomy and colostomy hemorrhage in the presence of portal hypertension and conclude that control of major stomal hemorrhage by local measures is often ineffective and that portasystemic shunts may significantly improve long-term prognosis.

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Citations

Dec 1, 1991·Diseases of the Colon and Rectum·C FuciniR R Dozois
Jul 1, 1990·Diseases of the Colon and Rectum·P L RobertsM C Veidenheimer
Apr 1, 1986·Diseases of the Colon and Rectum·R HesterbergH D Röher
May 1, 1988·Diseases of the Colon and Rectum·D E BeckS Grundfest-Broniatowski
Mar 11, 2008·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Bret J SpierMark Reichelderfer
Nov 16, 2012·Techniques in Coloproctology·M O Pennick, D Y Artioukh
Apr 1, 1990·Diseases of the Colon and Rectum·J V ConteR W Holt

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