Conservative treatment of bleeding stomal varices.

We treated seven cases of bleeding stomal varices and reviewed the literature. The average survival time of conservatively treated patients was 3.9 years. In many cases, other stigmata of liver disease later develop, such as pancytopenia, hepatic encephalopathy, and esophageal varices. Death from stomal bleeding is rare, and such bleeding can usually be controlled by local pressure, direct ligation, or parastomal varices. Death is usually from hepatic failure rather than bleeding per se, and there is no evidence that portosystemic shunting prolongs survival. Conservative therapy is preferable to portosystemic shunting, except when there are bleeding esophageal varices or when bleeding cannot be controlled by local measures.