# Management of refractory rectal variceal bleed using computed tomography

## TL;DR

A new minimally invasive CT-guided technique is described to stop severe rectal variceal bleeding when other treatments fail.

## Contribution

A novel percutaneous CT-guided NBCA glue injection method for refractory rectal variceal bleeding is introduced.

## Key findings

- CT-guided NBCA glue injection successfully stopped rectal variceal bleeding in a 28-year-old male.
- The technique was effective after endoscopic sclerotherapy had failed.
- The procedure provided immediate and complete cessation of bleeding.

## Abstract

The management of refractory rectal variceal bleed using a minimally invasive percutaneous approach is described. Rectal varices are
portosystemic collaterals that arise as a complication of portal hypertension. Bleeding is less common from rectal varices than from
esophageal varices, but it is potentially life-threatening. Hence, it is of interest to describe a novel minimally invasive percutaneous
technique to control refractory bleeding from rectal varices in a complex scenario where other proven treatments have failed. In the
present study, a 28-year-old male presented to the Emergency department with one episode of hematemesis, hematochezia and severe
abdominal pain. Sigmoidoscopy revealed actively bleeding rectal varices. CT abdominal angiogram revealed variceal formation in the
rectum. we successfully performed CT guided percutaneous N- butyl cyanoacrylate (NBCA) glue injection of rectal varices with immediate
and complete cessation of rectal bleed after failed endoscopic sclerotherapy.