CONTROL OF RUPTURED PERISPLENIC INTRAPERITONEAL VARICEAL BLEEDING VIA PERCUTANEOUS TRANSHEPATIC OBLITERATION (PTO) APPROACH.

Ectopic varices (EV) are portal vein collaterals developing anywhere in the abdomen except Gastroesophageal Junction (GEJ). The bleeding from ectopic varices, notably, the intraperitoneal varix is a dreadful complication, resulting in high mortality. We report a case of a 50-year lady with Hepatitis C related chronic liver disease, Child Pugh score (CTP) was 7, Model of End-stage Liver Disease (MELD) score of 6, with no prior liver decompensation, presented in the emergency department with signs of shock, low hemoglobin, and gross ascites. A CT scan abdomen revealed high-density ascites with an area of high density in the left upper quadrant, suggestive of intraperitoneal hemorrhage secondary to perisplenic intraperitoneal varices. After two failed attempts at Balloon Retrograde Transvenous Obliteration (BRTO) due to tight narrowing at splenorenal shunt, the patient underwent successful embolization of bleeding ectopic varices using Percutaneous Transhepatic Obliteration (PTO) via left portal vein access. The patient discharged on 7th post-admission day in hemodynamically stable condition. The use of PTO in bleeding intraperitoneal varices has not been frequently reported in the literature. This case demonstrates the efficacy of PTO in controlling ectopic peritoneal variceal bleeding in technically difficult cases, which are un-amenable to BRTO. [ABSTRACT FROM AUTHOR]