Extensive Idiopathic Colonic Varices in a Young Patient

Abstract

Varices of the colon are a rare cause of lower gastroin- testinal bleeding and are usually associated with portal hypertension or portal venous obstruction (1-4). There are numerous reports of bleeding from secondary colonic varices but very few of bleeding from idiopathic (primary) colonic varices. Among those, the rarest report varices throughout the entire colon. We report such a patient with recurrent episodes of life-threatening bleeding due to id- iopathic colonic varices throughout the entire colon. This is an exceptionally rare condition in such a young patient, treated successfully with a subtotal colectomy. examination findings were normal except for slight signs of fresh blood on rectal examination. Evaluation included normal WBC, platelet count, erythrocyte sedimentation rate, blood chemistry, coagulation studies, liver function tests, and albumin. Technetium scan showed signs of bleeding at the area of hepatic flexure. Selective inferior mesenteric angiography was normal during the arterial phase, and the venous phase showed dilated and tortuous veins in the sigmoid area, with suspected blood extravasation. A Meckel technetium scan was negative. An echocardiogram showed mild LV and RV dilatation. An abdominal computed tomographic (CT) scan was normal. An additional colonoscopy supported the findings of the previous one, with varices through the whole length of the colon and signs of active bleeding in the right colon. Due to repeated episodes of life-threatening anemia and hema- tochezia secondary to extensive colonic varices, the patient underwent a subtotal colectomy with ileorectal anastomosis showing vascular malformations and, occasionally, bleeding varices from the ileocecal valve to the rectum. At follow-up 4 years after the operation, his hematocrit was stable and no recurrent episodes of rectal bleeding had occurred.