An 85-year-old patient with multiple comorbidities, including a permanent colostomy after abdominoperineal resection for rectal adenocarcinoma and MASLD-related decompensated cirrhosis on primary prophylaxis with carvedilol, presented with four transfusion-requiring episodes of peristomal bleeding over six months. CT imaging demonstrated peristomal variceal collaterals. Due to comorbidities, an endoscopic therapeutic approach was selected. Transstomal EUS enabled identification of the ectopic varices and their feeding vessel. Combined coil-and-cyanoacrylate embolization was performed using two coil sets (6×14 mm and 8×14 mm, respectively), achieving immediate flow cessation. The patient was discharged 24 hours post-procedure with stable hemoglobin and no recurrent gastrointestinal hemorrhage during follow-up.