Idiopathic Isolated Colonic Varices: An Extremely Rare Condition

Abstract

Introduction: Colonic varices are an extremely rare phenomenon and they are even more unusual when occurring in isolation, in the absence of common comorbidities like- portal hypertension or portal vein thrombosis. We present this case of a 71-year-old asymptomatic woman, who was found to have this anomaly during routine colorectal cancer screening. They were deemed to be idiopathic colonic varices, as they did not result from any obvious underlying pathology. Case Presentation: A 71-year-old woman with medical history of obesity and hyperlipidemia first presented to the clinic for routine colorectal cancer screening. Patient denied any abdominal pain, nausea, vomiting, diarrhea, changes in weight, hematemesis or melena. She however reported few episodes of hematochezia a month earlier. Physical examination was unremarkable. Colonoscopy revealed multiple large colonic varices (Figure 1&2). In the absence of any underlying pathology, these prominent colonic varies are consistent with a diagnosis of idiopathic colonic varices, which is an extremely uncommon condition.Figure: Large colonic varices (blue arrow).Figure: Large colonic varices (blue arrow).Discussion: Ectopic varices is a term used to describe any portosystemic collateral veins that are dilated, circuitous, and located outside of the gastro-esophageal region. These varices are often caused by portal hypertension secondary to liver cirrhosis, but it is estimated that only 3.4% of patients with intrahepatic portal hypertension also have colonic varices. This means that even within the context of liver cirrhosis or portal hypertension, colonic varices are an unusual occurrence. Thus, it is not surprising then that idiopathic colonic varices, those of no clear origin, represent a particularly rare condition. One study cited that only 38 total cases of idiopathic colonic varices had been reported in the literature. Additional causes of colonic varices are congenital or familial venous anomalies, congestive heart failure, splenic vein thrombosis, and mesenteric vein obstruction. As seen with the patient in this case study, colonic varices often go undetected, especially if a patient is asymptomatic. This is problematic since many patients present with colonic varices for the first time by developing a massive lower gastrointestinal hemorrhage, which can be a life-threatening event. It has been advocated that CT angiography, given its precision and minimally invasive nature, is ‘gold standard' for diagnosis and is often the best option to ensure earlier detection.