# Transjugular Intrahepatic Porto-Systemic Shunt (TIPS), Mesenteric Vein Recanalization, and Rectal Varices Embolization Following Unsuccessful Endoscopic Management: A Case Report and Literature Review

## TL;DR

This case report describes a successful endovascular treatment for life-threatening rectal varices that did not respond to endoscopic methods.

## Contribution

The paper presents a novel combined approach using TIPS, mesenteric vein revascularization, and embolization for managing refractory rectal varices.

## Key findings

- Transjugular intrahepatic porto-systemic shunting (TIPS) and mesenteric vein revascularization effectively managed rectal varices.
- Variceal glue embolization provided immediate clinical success and a long recurrence-free interval.
- Image-guided interventions are critical for treating recalcitrant rectal variceal bleeding.

## Abstract

Rectal varices are rectal submucosal porto-systemic collaterals that develop secondary to portal hypertension in chronic liver disease. Bleeding from rectal varices is rare but potentially life-threatening. The management is typically endoscopic, with endovascular and surgical options for refractory cases. We present a case of endovascular salvage in a 58-year-old male patient with rectal varices causing life-threatening hematochezia, unresponsive to endoscopic procedures. Extensive rectal varices secondary to mesenteric venous obstruction were successfully managed with transjugular intrahepatic porto-systemic shunting (TIPS), mesenteric vein revascularization, and variceal glue embolization. Immediate technical and clinical success was followed by a long recurrence-free interval. The report highlights the importance of image-guided interventions for recalcitrant rectal variceal bleeding.