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We reviewed the literature for patients with this complex presentation and current recommendations, and commented on a case at our institution of a 68\u2010year\u2010old man with Child\u2010Pugh B alcoholic liver cirrhosis and hepatic encephalopathy who presented with profuse life\u2010threatening rectal variceal bleeding. Treatment options for rectal varices in patients with hepatic encephalopathy were reviewed and a management algorithm was devised from current knowledge in the literature. We suggest endoscopic management, and if unsuccessful then to proceed to angioembolization and\/or balloon\u2010occluded retrograde transvenous obliteration, which may be used in conjunction with surgical management. The chosen therapeutic option may depend on the clinical condition of the patient, the cause of portal hypertension and clinical expertise or facilities available. Given that transjugular intra\u2010hepatic portosystemic shunting is contraindicated in patients with hepatic encephalopathy, management of life\u2010threatening rectal variceal bleeding should be multimodal.<\/jats:p>","DOI":"10.1111\/ans.15982","type":"journal-article","created":{"date-parts":[[2020,5,14]],"date-time":"2020-05-14T14:22:56Z","timestamp":1589466176000},"page":"49-54","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Management options for rectal variceal bleeding in the setting of hepatic encephalopathy"],"prefix":"10.1111","volume":"91","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5025-6229","authenticated-orcid":false,"given":"Alice","family":"Lee","sequence":"first","affiliation":[{"name":"Colorectal Surgery Unit, Monash Health Dandenong Hospital  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3590-7780","authenticated-orcid":false,"given":"Thomas Surya","family":"Suhardja","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Unit, Monash Health Dandenong Hospital  Melbourne Victoria Australia"},{"name":"Department of Surgery, School of Clinical Sciences at Monash Health Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thang Chien","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Unit, Monash Health Dandenong Hospital  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanumant S.","family":"Chouhan","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Unit, Monash Health Dandenong Hospital  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,5,14]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"94","article-title":"Frequency of rectal varices in patients with cirrhosis","volume":"14","author":"Zuberi FF","year":"2004","journal-title":"J. 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