Acute colonic variceal bleeding treated with coil-assisted retrograde transvenous obliteration following atezolizumab-bevacizumab therapy for advanced hepatocellular carcinoma: A case report.
Sung Eun Park, Hyeon Uk Kwon, Sa Hong Jo et al.
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Case in brief
A 66-year-old man with alcohol-related cirrhosis and advanced hepatocellular carcinoma developed hematochezia the day after starting atezolizumab plus bevacizumab. Evaluation identified acute bleeding from ascending colonic varices in the setting of portal hypertension and portal vein thrombosis. The portocolonic shunt was embolized by coil-assisted retrograde transvenous obliteration using detachable coils and gelfoam slurry. Bleeding stopped immediately; he remained hemodynamically stable without further transfusion, and follow-up computed tomography showed successful embolization with no residual shunt.
What made this case unusual
The bleeding arose from ectopic colonic varices shortly after bevacizumab-based therapy, with portal vein thrombosis and a portocolonic shunt shaping the diagnostic and procedural context.
Diagnostic / clinical pearl
In a patient with portal hypertension who develops hematochezia, consider ectopic colonic varices, including when portal vein thrombosis is present; cross-sectional imaging can help define the shunt for intervention.
Why it matters
The case illustrates coil-assisted retrograde transvenous obliteration as a potential option for colonic variceal bleeding in the setting of portal vein thrombosis or complex portosystemic shunts.