Patients with a stoma have 5% chance of developing parastomal varices, which tend to repetitive massive and life-threatening hemorrhages. Treatment of choice in parastomal varices have not been established, while Transjugular Intrahepatic Portosystemic Shunt (TIPS) has been revealed as the most successful measure. We report a hemodynamically unstable 52-year-old patient with a history of Ulcerative Colitis (UC) and Primary Sclerosing Cholangitis (PSC) with colostomy, because of colon cancer who presented with massive parastomal bleeding. Non-operative treatments and TIPS failed to control the symptoms. Color Doppler ultrasound showed a hepato-fugal flow. The direct antegrade technique, using Sodium Tetradecyl Sulfate (STS 1%) and glue-Lipiodol, was applied under ultrasonography guidance, and complete stoppage of bleeding was achieved. No immediate or late complication or follow-up recurrence were noted after 8 months. In case of hepatofugal flow, direct percutaneous mesenteric parastomal venous access and sclerotherapy is a rapid and relatively safe procedure for parastomal variceal bleeding

All first-line management in order to control bleeding, failed. As a final point, sclerotherapy was prescribed for the patient in May 2019. A 22-gauge scalp vein was inserted under the ultrasonography guidance inferomedial part of the colostomy to the varices on the 92 Direct sclerotherapy in a patient with intractable parastomal bleeding Gastroenterol Hepatol Bed Bench 2020;13(1):90-94 mesenteric side. Obliteration of parastomal varices was applied using Sodium Tetradecyl Sulfate (STS 1%) via a routine two-syringe foam formation method.

No complication or follow-up recurrence were noted after 8 months.