Acute colonic variceal bleeding treated with coil-assisted retrograde transvenous obliteration following atezolizumab-bevacizumab therapy for advanced hepatocellular carcinoma: A case report.
4 affiliations
- 1Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea.
- 2Institute of Medical Sciences, Gyeongsang National University, Jinju, Republic of Korea.
- 3Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea.
- 4Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.
Abstract
Rationale
Colonic variceal bleeding is a rare but potentially life-threatening manifestation of portal hypertension. Bevacizumab therapy is associated with an increased risk of variceal bleeding, but bleeding from ectopic varices is less well recognized.Patient concerns
A 66-year-old man with alcohol-related cirrhosis and advanced hepatocellular carcinoma developed hematochezia on the day following the initiation of atezolizumab plus bevacizumab therapy.Diagnoses
Acute ascending colonic variceal bleeding in the setting of portal hypertension and portal vein thrombosis.Interventions
Coil-assisted retrograde transvenous obliteration (CARTO) was performed via the right common femoral vein. The portocolonic shunt was embolized using detachable coils and gelfoam slurry.Outcomes
Hematochezia ceased immediately after the procedure, and the patient remained hemodynamically stable without further transfusion. Follow-up computed tomography confirmed successful embolization of the variceal complex without residual shunt.Lessons
CARTO may be an effective treatment option for colonic variceal bleeding, particularly in patients with portal vein thrombosis or complex portosystemic shunts. Clinicians should remain aware of the potential for bleeding from ectopic varices in patients receiving bevacizumab-based therapy.
Related
- Early antibiotic exposure, but not late exposure, negatively affects the clinical outcomes of first-line atezolizumab plus bevacizumab in patients with unresectable hepatocellular carcinoma
- Real-world evidence for atezolizumab with bevacizumab for unresectable hepatocellular carcinoma: a multicentre UK Midlands cohort
- Prognostic Significance of Response Dynamics in Atezolizumab plus Bevacizumab-Treated Hepatocellular Carcinoma: A Multicenter Real-World Validation Study.
- von Willebrand Factor and ADAMTS13 Predict Therapeutic Efficacy and Severe Adverse Events in Advanced Hepatocellular Carcinoma Treated With Atezolizumab-Bevacizumab.
- Atezolizumab Plus Bevacizumab Treatment for Patients With Hepatocellular Carcinoma in the Barcelona Clinic Liver Cancer B2 Stage
BibTeX
@article{park2026acute,
title = {{Acute colonic variceal bleeding treated with coil-assisted retrograde transvenous obliteration following atezolizumab-bevacizumab therapy for advanced hepatocellular carcinoma: A case report.}},
author = {Sung Eun Park and Hyeon Uk Kwon and Sa Hong Jo and Sung Gong Lim and Ji Yoon Kwak and Ji Hee Han and Hankyu Jeon and Ra Ri Cha and Jae Min Lee and Hyun Jin Kim and Sang Soo Lee},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051084},
url = {https://europepmc.org/article/MED/42888536},
note = {CC BY},
}
RIS
TY - JOUR
TI - Acute colonic variceal bleeding treated with coil-assisted retrograde transvenous obliteration following atezolizumab-bevacizumab therapy for advanced hepatocellular carcinoma: A case report.
AU - Sung Eun Park
AU - Hyeon Uk Kwon
AU - Sa Hong Jo
AU - Sung Gong Lim
AU - Ji Yoon Kwak
AU - Ji Hee Han
AU - Hankyu Jeon
AU - Ra Ri Cha
AU - Jae Min Lee
AU - Hyun Jin Kim
AU - Sang Soo Lee
PY - 2026
DA - 2026/10/01
JO - Medicine
DO - 10.1097/md.0000000000051084
UR - https://europepmc.org/article/MED/42888536
AB - Rationale Colonic variceal bleeding is a rare but potentially life-threatening manifestation of portal hypertension. Bevacizumab therapy is associated with an increased risk of variceal bleeding, but bleeding from ectopic varices is less well recognized.Patient concerns A 66-year-old man with alcohol-related cirrhosis and advanced hepatocellular carcinoma developed hematochezia on the day following the initiation of atezolizumab plus bevacizumab therapy.Diagnoses Acute ascending colonic variceal bleeding in the setting of portal hypertension and portal vein thrombosis.Interventions Coil-assisted retrograde transvenous obliteration (CARTO) was performed via the right common femoral vein. The portocolonic shunt was embolized using detachable coils and gelfoam slurry.Outcomes Hematochezia ceased immediately after the procedure, and the patient remained hemodynamically stable without further transfusion. Follow-up computed tomography confirmed successful embolization of the variceal complex without residual shunt.Lessons CARTO may be an effective treatment option for colonic variceal bleeding, particularly in patients with portal vein thrombosis or complex portosystemic shunts. Clinicians should remain aware of the potential for bleeding from ectopic varices in patients receiving bevacizumab-based therapy.
SN - 0304-5412
SN - 1536-5964
ER -