Percutaneous transhepatic obliteration following endoscopic variceal ligation for rectal varices: a case report

A 78-year-old woman with liver cirrhosis was admitted with hematochezia. Colonoscopy revealed rectal varices, and endoscopic variceal ligation (EVL) was performed at a red plug. Post-procedural computed tomography (CT) demonstrated markedly developed rectal varices. The inferior mesenteric vein was dilated, and no other major collaterals were identified, suggesting rapid variceal flow. Endoscopic injection sclerotherapy (EIS) was considered challenging because of the difficulty in retaining the sclerosant and the potential risk of systemic leakage. Balloon-occluded retrograde transvenous obliteration (BRTO) was not feasible because no accessible route was available. Consequently, percutaneous transhepatic obliteration (PTO) was performed. Follow-up CT demonstrated reduced variceal enhancement. This case suggests that PTO is a valuable therapeutic option for rectal varices when endoscopic treatment carries high risk.