One recognized complication of portal hypertension in a patient with an ileal urinary conduit is variceal hemorrhage. The definitive treatment for this rare complication is controversial. Local measures, sclerotherapy, stomal revision and various operative portacaval shunts have been described but they have had limited long-term success. Using a recently developed interventional radiological technique, a transjugular intrahepatic portosystemic shunt was created in a cirrhotic man who had recurrent massive ileal conduit variceal hemorrhage. After the procedure the patient experienced no further life threatening stomal hemorrhage. He died of hepatic failure 6 months later.