Management of parastomal variceal bleeding in an adult with metastatic liver cancer: A case-based review

Parastomal variceal bleeding is a rare but potentially life-threatening complication in patients with portal hypertension and intestinal stomas, for which evidence-based management strategies remain poorly defined. A case-based review was performed synthesizing available literature and institutional experience to evaluate diagnostic approaches and treatment modalities for parastomal variceal bleeding, with emphasis on acute control, prevention of recurrence, and multidisciplinary management. Reported management strategies include medical optimization of portal hypertension, local measures, endovascular embolization, transjugular intrahepatic portosystemic shunt placement, and surgical revision, each with variable efficacy and recurrence risk; no single approach was universally effective. The management of parastomal variceal bleeding in adults should be individualized and directed by severity of bleeding, etiology of portal hypertension, hepatic reserve, comorbidities, prognosis and anatomical suitability for intervention. We recommend using a multi-disciplinary, stepwise approach although treatment should be guided by underlying etiologies and patient specific goals.