Management of Severe Rectal Variceal Bleeding in a Patient With Alcohol-Related Cirrhosis: A Case Report

Rectal varices (RV) are portosystemic collaterals that are a result of portal hypertension. RV prevalence has been reported between 63% and 94% among patients with cirrhosis; however, clinically significant bleeding is a rare complication and occurs in about 0.5% to 5% of patients. To date, no specific evidence-based guidelines exist for the management of bleeding RV, which can be life-threatening with a high morbidity and mortality. Current management involves a multidisciplinary team and urgent endoscopic evaluation in all patients. Here, we present a rare case of severe RV bleeding in a patient with cirrhosis presumed secondary to alcohol use, who ultimately expired despite multiple endoscopic interventions and salvage therapies. The patient's deteriorating condition from severe hemorrhagic shock and limitation of procedures given poor candidacy for transjugular intrahepatic portosystemic shunt (TIPS) highlights the limited treatment options available in such advanced cases. It warrants further discussions on establishing dedicated guidelines and advancing therapies for refractory cases.