Distal inferior mesenteric veins to renal vein shunt for treatment of bleeding anorectal varices: case report and review of literature

Isolated intractable bleeding from anorectal varices is a rare complication of portal hypertension. We report a case of a patient with cirrhosis and hepatofugal flow who had severe lower gastrointestinal bleeding from anorectal varices. This is the first case report of construction of a distal inferior mesenteric vein shunt to left renal vein as a selective shunt for treatment of bleeding anorectal varices in a patient with hepatofugal flow. The patient is a 39-year-old white man with a medical history significant for alcohol abuse who was seen with bright red blood per rectum requiring 10 units of packed red blood cells over the course of a year. The work-up revealed anorectal varices with no other colonic lesions. The patient underwent construction of a distal inferior mesenteric vein to left renal vein shunt.