Lee Alice, Suhardja Thomas Surya, Nguyen Thang Chien, Chouhan Hanumant S
Colorectal Surgery Unit, Monash Health, Dandenong Hospital, Melbourne, Victoria, Australia.
Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.
ANZ J Surg. 2021 Jan;91(1-2):49-54. doi: 10.1111/ans.15982. Epub 2020 May 14.
Bleeding related to rectal varices associated with portal hypertension is rare but life-threatening, and requires prompt treatment. We reviewed the literature for patients with this complex presentation and current recommendations, and commented on a case at our institution of a 68-year-old man with Child-Pugh B alcoholic liver cirrhosis and hepatic encephalopathy who presented with profuse life-threatening rectal variceal bleeding. Treatment options for rectal varices in patients with hepatic encephalopathy were reviewed and a management algorithm was devised from current knowledge in the literature. We suggest endoscopic management, and if unsuccessful then to proceed to angioembolization and/or balloon-occluded retrograde transvenous obliteration, which may be used in conjunction with surgical management. The chosen therapeutic option may depend on the clinical condition of the patient, the cause of portal hypertension and clinical expertise or facilities available. Given that transjugular intra-hepatic portosystemic shunting is contraindicated in patients with hepatic encephalopathy, management of life-threatening rectal variceal bleeding should be multimodal.
与门静脉高压相关的直肠静脉曲张出血虽罕见但危及生命，需要及时治疗。我们查阅了有关此类复杂病例的文献及当前建议，并对我院一名68岁患有Child-Pugh B级酒精性肝硬化和肝性脑病的男性患者进行了病例分析，该患者出现了危及生命的大量直肠静脉曲张出血。我们回顾了肝性脑病患者直肠静脉曲张的治疗选择，并根据文献中的现有知识设计了一种管理算法。我们建议采用内镜治疗，若不成功则进行血管栓塞和/或球囊闭塞逆行静脉闭塞术，这些方法可与手术治疗联合使用。所选择的治疗方案可能取决于患者的临床状况、门静脉高压的病因以及临床专业知识或可用设施。鉴于经颈静脉肝内门体分流术在肝性脑病患者中是禁忌的，危及生命的直肠静脉曲张出血的管理应采用多模式治疗。
