Management of colostomal hemorrhage resulting from portal hypertension

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Abstract
Colostomy and ileostomy stomal hemorrhage is a rare and potentially fatal complication of portal hypertension. Two patients with colostomy stomal hemorrhage who had both undergone abdominoperineal resection for carcinoma of the rectosigmoid colon are descirbed. One patient, in the absence of metastatic disease with minimal to moderate functional hepatic impairment, underwent a mesocaval interposition graft shunt and had no recurrence of stomal hemorrhage during the 4-mo. postoperative period. The other patient, in the presence of metastatic disease to the lungs and liver, was not shunted and died of hepatic and renal failure. Angiography, in particular splenoportography, is extremely helpful in establishing the diagnosis of portal hypertension and planning appropriate operative procedure. The literature on ileostomy and colostomy hemorrhage in the presence of portal hypertension was reviewed. Control of major stomal hemorrhage by local measures is often ineffective and portasystemic shunts may significantly improve long-term prognosis.