Stomal varices: a cause for intermittent haematuria post-radical cystectomy.

To cite: Lee S-M, Yogan K, Carr T. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2015214082 DESCRIPTION A 74-year-old man presented to hospital with intermittent episodes of frank, painless haematuria, 2 years post-radical cystectomy with ileal conduit. Stoma examination revealed dilated stomal varices and peri-stomal ecchymoses (figure 1). An abdominal CT scan confirmed a thickened distal ileal conduit and a cirrhotic liver with dilated portal venous system. A diagnosis of stomal varices secondary to portal hypertension and liver cirrhosis was made. The patient underwent suture ligation of the bleeding varices. Haematuria from ileal conduits may arise from a variety of conditions, including infections, calculi and recurrent disease, and it is vital to exclude these common conditions. Stomal varices occur at the mucocutaneous junction and are characterised by a surrounding purplish hue. They are an example of ectopic varices, that is, dilated portosystemic collateral veins in unusual sites. Ectopic varices account for approximately 1–5% of all variceal bleeding and only rarely have they been reported in ileal conduit stomas. Bleeding due to stomal varices can lead to significant haematuria and blood loss, and early recognition is vital. Management is challenging; local treatment, including pressure, cautery, sclerotherapy and suture ligation, may be effective in the short term. However, if these fail to halt recurrent bleeding, management of underlying liver disease and portal hypertension is required. β-Blockers, somatostatin analogues and vasopressin have been used to reduce portal hypertension, but some patients require surgical or radiologically guided shunts to decompress the portal venous system. Surgeons should consider this unusual cause in their differentials for haematuria in the radical cystectomy patient.