Rectal varices treated by retrograde transvenous obliteration
Bibliographic record
Abstract
A 74-year-old man, known for Child-Pugh class C cirrhosis secondary to NASH (Non-alcoholic Steatohepatitis) and primary sclerosing cholangitis, undergoes recurrent paracentesis and has been hospitalized for hepatic encephalopathy multiple times. Transjugular intrahepatic portosystemic shunt procedure was denied in 2020. His last endoscopy showed small oesophageal varices and large rectal varices that developed while he was treated with nadolol. He presents this time with lower gastrointestinal bleeding and syncope. His haemoglobin level at arrival was 76 g L−1. We found a large rectal mass of 8 × 4 cm during the physical examination. The mass was determined to be caused by prolapse of large rectal varices (Figure 1). Angioscan revealed a significant shunt via the inferior mesenteric vein giving rise to voluminous peri-rectal varices. He received transfusions, Ceftriaxone, and Somatostatin. Endoscopy was not possible due to the position of the varices and, given his medical history, the patient was not a candidate for surgery. After stabilization, the patient was then transferred to a centre where an endovascular variceal obliteration was performed in radiology. Rectal varices upon arrival at emergency department. Determining the optimal treatment for anorectal varices is still an ongoing process. Endoscopy techniques, interventional radiology techniques, and surgical interventions have been attempted in small case studies, but their effectiveness is variable.(1–3) We present a case where lower gastrointestinal bleeding from large rectal varices was resolved by retrograde transvenous obliteration. The blood flow to the rectal varices was completely obliterated with STS foam. There were no peri-operative complications. None declared. None declared. There are no new data associated with this article.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".