Rectal variceal bleeding occurs in 38% of patients with portal hypertension leading to an overall mortality in 5%. Conventional management involves endoscopic measures utilizing sclerotherapy/glue injection/banding ligation or surgical management. Some patients, mostly Child A or B cirrhotics, pose difficulty for traditional management and have been shown to benefit from transjugular intrahepatic portosystemic shunting (TIPSS) or interventional balloon occluded shunt embolization procedures, balloon occluded transvenous obliteration being the most common used modality, however, seldom reported in literature. In this report, we present the case, through striking images and real time step by step procedural video; of a difficult to control rectal variceal bleeding in a Child C cirrhotic in whom, balloon occluded antegrade glue embolization of multiple shunts was performed with beneficial outcomes.
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