Successful hybrid surgery for ileal conduit stomal varices following oxaliplatin-based chemotherapy in a patient with advanced colorectal cancer

Surgical Case Reports

Hirofumi Kawanaka¹  Masahiko Sugiyama²  Hideo Uehara²  Masaru Morita²  Tomonori Nakanoko²  Mitsuhiko Ota²  Yasushi Toh²  Yohei Mano³  Keishi Sugimachi³ 

[1] Clinical Research Institute and Department of Surgery, National Hospital Organization Beppu Medical Center;Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center;Department of Hepatobiliary-Pancreatic Surgery, National Hospital Organization Kyushu Cancer Center;

关键词: Ectopic varices;    Colorectal cancer;    Hybrid surgery;    Sinusoidal obstruction;   

DOI  :  10.1186/s40792-020-01021-6

来源: DOAJ

【 摘 要 】

Abstract Background Ectopic variceal bleeding is a rare but life-threatening complication of portal hypertension (PH). Oxaliplatin-based chemotherapy for colorectal cancer (CRC) is associated with sinusoidal obstruction syndrome of the liver, which can lead to PH. Case presentation Here, we report a successful hybrid surgery that included intraoperative obliteration of ileal conduit stomal varices (ICSVs) for a 66-year-old woman with CRC and liver metastasis that had been treated multimodally during the previous 4 years, including 17 courses of oxaliplatin-based chemotherapy. She was admitted to our hospital for massive hemorrhage from an ileal conduct stoma. Image findings showed ICSVs as a part of portosystemic shunt, which were afferently supplied from the superior mesenteric vein (SMV) and drained by the numerous cutaneous veins connected to the left femoral vein. Obliteration of the stomal varices by interventional radiologic techniques alone was inappropriate because of difficulties of cannulating the efferent cutaneous veins. We, therefore, performed hybrid surgery for the ICSV, which included cannulation into the SMV branch and antegrade obliteration of the varices with a 5% solution of ethanolamine oleate with iopamidol under blocking the SMV flow, using a vascular clip and ligation. Hemorrhage in her ileal conduit stoma disappeared completely. Conclusion Customized treatment of ectopic varices should be based on their precise vascular anatomy; hybrid surgery with intraoperative angiography is an alternative treatment for ectopic varices such as ICSV.

【 授权许可】

Unknown