Variceal bleeding from an ileal conduit stoma is an uncommon complication of portal venous hypertension. We report on a 59-year-old man who experienced frequent and severe bleeding episodes from the parastomal skin and mucosa of an ileal conduit requiring multiple blood transfusions. A mesenteric angiogram showed portal hypertension and large varices around the ileal conduit. Resolution of the dilated cutaneous veins occurred after a portosystemic shunt and he has had no further bleeding episodes. Recognition of this unusual complication of ileostomy formation is important for urological surgeons who may encounter patients with liver disease requiring urinary diversion.