Balloon-occluded retrograde transvenous obliteration (BRTO) is an endovascular technique frequently employed in the management of bleeding gastric varices among patients with portal hypertension. Bleeding from gastric varices is associated with higher mortality and morbidity compared to bleeding from esophageal varices, which are typically managed endoscopically. Compared to other interventions for gastric varices, BRTO is less invasive and can be performed in patients with poor hepatic reserve. The procedure involves occlusion of the outflow of the portosystemic shunt— often a gastrorenal shunt—using an occlusion balloon, followed by injection of a sclerosant into the varix. In this report, we describe a technique for accessing gastric varices that lack a gastrorenal shunt; this is accomplished using alternative shunt routes, such as the inferior phrenic vein. The reported approach is technically challenging due to the relatively small size of these shunts and the scarcity of cases documented in the literature regarding their use.

Portal hypertension, a known complication of liver cirrhosis, typically leads to variceal bleeding in the esophagus and stomach. However, ectopic varices can also occur outside the gastroesophageal region and may present with life-threatening massive bleeding. We report a case of bleeding ileal ectopic varices in a patient with cirrhosis that were not detected during routine endoscopy. These varices were ultimately diagnosed with the aid of abdominal computed tomography. A transjugular intrahepatic portosystemic shunt (TIPS) was created to decrease portal pressure, and the TIPS tract was then used to selectively embolize the bleeding ectopic ileal varices.

Balloon-occluded retrograde transvenous obliteration (BRTO) is an endovascular technique frequently employed in the management of bleeding gastric varices among patients with portal hypertension. Bleeding from gastric varices is associated with higher mortality and morbidity compared to bleeding from esophageal varices, which are typically managed endoscopically. Compared to other interventions for gastric varices, BRTO is less invasive and can be performed in patients with poor hepatic reserve. The procedure involves occlusion of the outflow of the portosystemic shunt— often a gastrorenal shunt—using an occlusion balloon, followed by injection of a sclerosant into the varix. In this report, we describe a technique for accessing gastric varices that lack a gastrorenal shunt; this is accomplished using alternative shunt routes, such as the inferior phrenic vein. The reported approach is technically challenging due to the relatively small size of these shunts and the scarcity of cases documented in the literature regarding their use.

Portal hypertension, a known complication of liver cirrhosis, typically leads to variceal bleeding in the esophagus and stomach. However, ectopic varices can also occur outside the gastroesophageal region and may present with life-threatening massive bleeding. We report a case of bleeding ileal ectopic varices in a patient with cirrhosis that were not detected during routine endoscopy. These varices were ultimately diagnosed with the aid of abdominal computed tomography. A transjugular intrahepatic portosystemic shunt (TIPS) was created to decrease portal pressure, and the TIPS tract was then used to selectively embolize the bleeding ectopic ileal varices.

Balloon-occluded retrograde transvenous obliteration (BRTO) is an endovascular technique frequently employed in the management of bleeding gastric varices among patients with portal hypertension. Bleeding from gastric varices is associated with higher mortality and morbidity compared to bleeding from esophageal varices, which are typically managed endoscopically. Compared to other interventions for gastric varices, BRTO is less invasive and can be performed in patients with poor hepatic reserve. The procedure involves occlusion of the outflow of the portosystemic shunt— often a gastrorenal shunt—using an occlusion balloon, followed by injection of a sclerosant into the varix. In this report, we describe a technique for accessing gastric varices that lack a gastrorenal shunt; this is accomplished using alternative shunt routes, such as the inferior phrenic vein. The reported approach is technically challenging due to the relatively small size of these shunts and the scarcity of cases documented in the literature regarding their use.

Portal hypertension, a known complication of liver cirrhosis, typically leads to variceal bleeding in the esophagus and stomach. However, ectopic varices can also occur outside the gastroesophageal region and may present with life-threatening massive bleeding. We report a case of bleeding ileal ectopic varices in a patient with cirrhosis that were not detected during routine endoscopy. These varices were ultimately diagnosed with the aid of abdominal computed tomography. A transjugular intrahepatic portosystemic shunt (TIPS) was created to decrease portal pressure, and the TIPS tract was then used to selectively embolize the bleeding ectopic ileal varices.