North Texas Research Forum 2026

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Division

North Texas

Hospital

Medical City Arlington

Specialty

Internal Medicine

Document Type

Poster

Publication Date

2026

Keywords

hematuria, vesicular varices, cirrhosis

Disciplines

Internal Medicine | Male Urogenital Diseases | Medicine and Health Sciences

Abstract

Background Hematuria secondary to vesicular varices is a rare but serious complication of portal hypertension, often associated with liver cirrhosis. Effective management requires a multidisciplinary approach, often involving urology, gastroenterology, and interventional radiology to address acute bleeding and prevent recurrence.

Case Presentation We present a case of a patient with alcoholic liver cirrhosis who experienced severe hematuria, highlighting the diagnostic and therapeutic challenges encountered. The patient presented with a two-day history of acute hematuria and blood clots, ultimately attributed to vesicular varices secondary to portal hypertension from alcoholic liver cirrhosis. Urology was consulted, who recommended continuous bladder irrigation (CBI), initially resolving the hematuria. Removal of the Foley catheter for a voiding trial resulted in recurrent hematuria that led to severe hypotension and a hemoglobin drop from 12 to 8 g/dL, necessitating rapid response and transfer to the intensive care unit. The patient received multiple blood transfusions and CBI was resumed. Gastroenterology was consulted to evaluate the need for esophagogastroduodenoscopy and assist with managing cirrhosis. In addition, interventional radiology was urgently consulted to also provide input for interventions. The patient underwent cystoscopy with fulguration of the bleeding varices, the largest of which measured approximately 2cm across. Due to the size of the varices and the high risk of rebleeding, the patient then underwent paraumbilical vein embolization to prevent further bleeding. There was no recurrence of hematuria afterwards and the patient was able to be discharged home in stable condition.

Lessons Learned/Conclusion This case underscores the importance of coordinated multidisciplinary care in managing complex hematuria due to vesicular varices in the context of portal hypertension. If not recognized early and properly managed, patients can suffer adverse effects such as exsanguination from rapid blood loss.

Original Publisher

HCA Healthcare Graduate Medical Education

Navigating Recurrent Hematuria in Vesicular Varices: A Case of Successful Multidisciplinary Intervention

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