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Case report
Halting the haematochezia
  1. Meera Mistry1,
  2. Joseph Fiske1,
  3. Tehreem Chaudhry1,
  4. Timothy J Cross1,
  5. Shemin Mehta2,
  6. Khaled Ballal2,
  7. Previn Diwakar2,
  8. James Chambers2,
  9. Philip J Smith1
  1. 1 Department of Gastroenterology and Hepatology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
  2. 2 Department of Radiology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, Liverpool, UK
  1. Correspondence to Dr Philip J Smith, Department of Gastroenterology and Hepatology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, L7 8XP, UK; Philip.Smith{at}


An elderly gentleman with primary sclerosing cholangitis (PSC) was admitted with rectal bleeding, shown on flexible sigmoidoscopy to be arising from rectal varices, which bled despite endoscopic therapy with histoacryl glue. Therapeutic options were limited with surgery and transjugular intrahepatic portosystemic shunt deemed too high risk, and endovascular embolisation through interventional radiology was sought. Coil-assisted retrograde transvenous obliteration was used to good effect. This rare approach has advantages over balloon occlusion, avoiding long indwelling balloon time and risk of rupture or infection, as well as time efficiency.

  • bleeding
  • portal hypertension
  • primary sclerosing cholangitis
  • interventional radiology

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  • MM and JF are joint first authors.

  • Twitter @DrPhilipJSmith

  • Contributors MM, JF and PJS prepared the manuscript and figures. JC prepared the radiology images and reports. SM, KB and PD performed the embolisation procedure. TC, TJC and PJS managed the patient clinically. PJS supervised the manuscript preparations. All authors approved the submitted manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.