Recurrent ileocolic variceal hemorrhage treated with superselective Onyx embolization: A case report

Ileocolic and appendicular varices are rare causes of lower gastrointestinal bleeding and are frequently missed on endoscopic evaluation. We present the case of a 35-year-old woman with ulcerative colitis, primary sclerosing cholangitis, and cirrhosis who presented with recurrent hematochezia and severe anemia. Contrast enhanced CT with venous-phase imaging revealed clusters of enhancing ileal varices, and angiography demonstrated ileocolic and appendicular varices with a significant portosystemic shunt draining into the inferior vena cava. Superselective embolization using Onyx followed by glue embolization resulted in complete cessation of bleeding. This case highlights the diagnostic value of multiphase contrast-enhanced CT including venous phase imaging and the effectiveness of minimally invasive endovascular treatment for rare ectopic varices.