Ileal conduit stomal hemorrhage as the first presentation of end stage liver disease: case report and review of the literature.

Hemorrhage from an ileal conduit is a rare and potentially life threatening event with only 17 cases reported in the medical literature. We present the unique case of an 83-year-old patient with acute stomal hemorrhage as the first sign of underlying liver disease and portal hypertension. Bleeding was controlled with conservative measures including balloon tamponade, betablockade, octreotide, and suture ligation. Our review of the literature revealed multiple management options for stomal hemorrhage with most authors advocating definitive management via portosystemic shunt creation, either surgically, or with transjugular intrahepatic portosystemic shunt (TIPS). In all cases the incidence of rebleeding associated with the procedure, and the ability of the patient to undergo invasive procedures, must be considered carefully.