A 45-year-old man developed a low-grade rectal carcinoma just above the anorectal margin. He underwent an abdominoperineal resection of the tumor and was left with a left lower abdominal colostomy (see below). Unfortunately, the man’s wife left him for a number of reasons, including lack of sexual desire. He “turned to drink” and over the ensuing years developed cirrhosis. He was brought into the emergency room with severe bleeding from enlarged veins around his colostomy. An emergency transjugular intrahepatic portosystemic shunt was created, which stopped all bleeding (eFigs. 4.189 and 4.190). He is now doing well in a rehabilitation program.