# Management of Severe Rectal Variceal Bleeding in a Patient With Alcohol-Related Cirrhosis: A Case Report

## TL;DR

This case report describes a rare and fatal instance of severe rectal variceal bleeding in a patient with alcohol-related cirrhosis, highlighting the challenges in managing such life-threatening complications.

## Contribution

The paper presents a rare clinical case emphasizing the need for dedicated guidelines and improved therapies for severe rectal variceal bleeding.

## Key findings

- Severe rectal variceal bleeding occurred in a patient with alcohol-related cirrhosis despite multiple interventions.
- The patient expired due to hemorrhagic shock and limited treatment options, including ineligibility for TIPS.
- The case underscores the lack of evidence-based guidelines and the need for better therapies for refractory cases.

## Abstract

Rectal varices (RV) are portosystemic collaterals that are a result of portal hypertension. RV prevalence has been reported between 63% and 94% among patients with cirrhosis; however, clinically significant bleeding is a rare complication and occurs in about 0.5% to 5% of patients. To date, no specific evidence-based guidelines exist for the management of bleeding RV, which can be life-threatening with a high morbidity and mortality. Current management involves a multidisciplinary team and urgent endoscopic evaluation in all patients. Here, we present a rare case of severe RV bleeding in a patient with cirrhosis presumed secondary to alcohol use, who ultimately expired despite multiple endoscopic interventions and salvage therapies. The patient’s deteriorating condition from severe hemorrhagic shock and limitation of procedures given poor candidacy for transjugular intrahepatic portosystemic shunt (TIPS) highlights the limited treatment options available in such advanced cases. It warrants further discussions on establishing dedicated guidelines and advancing therapies for refractory cases.