Urostomy-associated stomal variceal hemorrhage secondary to portal hypertension: A case report and interventional radiology-guided management.

Stomal varices are a rare manifestation of ectopic portosystemic collateralization in patients with portal hypertension and are most commonly reported in association with ileostomies and colostomies. Stomal variceal hemorrhages are associated with significant morbidity, high rebleeding rates, and mortality of approximately 3%-4% per bleeding episode. To date, there has been limited discussion on treatment strategies for urostomy-associated stomal varices. We report a case of recurrent, transfusion-dependent bleeding from an ileal conduit urostomy in a 58-year-old man with portal hypertension secondary to metabolic dysfunction-associated steatohepatitis (MASH) and alcohol-related cirrhosis. Despite multiple interventional radiology-guided embolization procedures, bleeding persisted until definitive portal decompression was achieved with transjugular intrahepatic portosystemic shunt (TIPS) placement. This case highlights urostomy-associated stomal varices as a less familiar manifestation of ectopic variceal bleeding and emphasizes the importance of addressing portal hypertension along with isolated variceal obliteration. TIPS provided durable hemostasis after variceal embolization failure and should be considered early in refractory stomal bleeding.