A Rare Case of Idiopathic Colonic Varices in a Young Male

Abstract

Less than 35 cases of idiopathic colonic varices have been reported in the English medical literature. Bleeding idiopathic colonic varices are even rarer. We present the case of a young male with bloody diarrhea whose colonoscopy showed colonic varices which even after thorough investigation did not reveal an identifiable etiology. A 32 year old Hispanic male presented with multiple episodes of painless bloody diarrhea, occurring intermittently for the last 10 years. The patient did not drink alcohol, but smoked 4-5 cigarettes/day. He did not have any other past medical history. On physical exam, pale conjunctiva was the only significant finding. Stool studies were positive for fecal WBC but negative for cultures, C. diff, ova, parasites and cysts. Hb was 6.5, with normal WBC, platelets and LFTs. Colonoscopy 3 years ago had revealed prominent vasculature throughout the colon. There were three inflammatory polyps. Random colonic biopsies showed benign colonic mucosa. Colonoscopy done this admission revealed varices in the rectosigmoid junction, sigmoid colon and hepatic flexure and AVM in the sigmoid colon, while no active bleeding was noted. CT of abdomen and pelvis with contrast showed unremarkable liver, spleen, pancreas with patent celiac trunk, superior and inferior mesenteric artery. Doppler ultrasound of abdomen showed fatty liver with no evidence of biliary dilatation and normal duplex Doppler flow patterns in the main portal vein, hepatic vein branches, abdominal aorta, IMA, SMA and visualized portions of IVC. Mesenteric angiography, which is the gold standard test to evaluate colonic varices, could not be done in this patient as he left against medical advice. Secondary colonic varices are caused by portal hypertension usually due to liver cirrhosis or portal vein thrombosis. Our patient did not have any signs of portal hypertension and the imaging studies revealed patent intra-abdominal blood vessels. Previous studies have indicated a familial component to idiopathic varices. The hypothesis that these might be the result of congenital vascular anomalies is supported in this patient by him also having an AVM in the sigmoid colon. Knowledge of these varices will avoid the risk of causing hemorrhage by doing a biopsy when they are mistakenly identified as polyps or tumors.Figure 1