A Case of Ileal Conduit Bleeding Caused by Porto‐Sinusoidal Vascular Disorder

A 60‐year‐old man presented with recurrent stomal bleeding for 3 years. He had undergone cystoprostatectomy with ileal conduit diversion for bladder cancer 7 years prior. Endoscopy revealed multiple protruding lesions (0.6–0.8 cm) inside the stoma, which were initially suspected to be ectopic varices given concomitant esophageal varices and splenomegaly. Baseline liver function, renal function and coagulation profiles were all normal. Hemodynamic assessments showed a normal hepatic venous pressure gradient of 4 mmHg but an elevated portal pressure gradient (PPG) of 15 mmHg. Portal vein stenosis, incomplete septal fibrosis, portal tract vascular congestion, and abnormal periportal vessels without pseudolobule formation were founded in liver biopsy, confirming the diagnosis of porto‐sinusoidal vascular disorder (PSVD). Transjugular intrahepatic portosystemic shunt (TIPS) combined with variceal embolization was thereafter performed, reducing PPG to 5 mmHg. At 12‐month follow‐up, no stomal bleeding recurrence occurred, and the stent patency was maintained. This case suggests that PSVD needs to be considered in patients with non‐cirrhotic portal hypertension, and ectopic varices merit attention in the setting of portal hypertension.