S1852 Colonic Varices Due to Alcoholic Cirrhosis

Abstract

Introduction: Ectopic varices (all varices outside the gastroesophageal region) account for 1-5% of all variceal bleeding episodes. Specifically, colon varices are rare, as incidence of colonic varices, irrespective of etiology, is around 0.07%. If colonic varices bleed, treatment is urgent, as delay in treatment can potentially be fatal. Case description/methods: A 55 year old male with a past medical history of complicated diverticulitis status post open sigmoidectomy and heavy alcohol abuse with history of deliriums tremens who was admitted due to having hematochezia with bowel movements for two days. He denied any hematemesis, abdominal pain, melena or NSAID use. Patient was hypotensive on arrival to the ED with MAPs in the 40s. On physical exam, scleral icterus along asterixis and tremors in his hands were noted. CTA Abdomen and Pelvis showed no signs of active gastrointestinal bleeding with signs of hepatic cirrhosis with extensive esophageal, gastric varices, and descending colon varices. Patient had two more episodes of hematochezia in the ED. Patient was given 2 units of emergent blood in the ED to help stabilize his blood pressure. Patient did not have a diagnosis of cirrhosis prior to presentation. He admitted to drinking a six pack of beer daily for the past thirty years. Last colonoscopy was five years ago which showed tubular adenomatous polyps in the rectum and ascending colon. Diverticulosis was also present in the ascending colon. Patient had EGD performed which showed some mild esophagitis and some portal hypertensive gastropathy (PHG) located in the antrum, body and fundus. Flexible sigmoidoscopy was then performed which showed a large amount of fresh and old blood coming from a sigmoid varix at 25 cm located in the sigmoid colon. Hemostasis was achieved with using a Bear claw clip (Figure 1). Discussion: Colonic varices can develop secondary to portal hypertension, congenital anomalies in venous outflow, mesenteric or splenic vein thrombosis, congestive heart failure, or formation of collateral vessels from previous abdominal surgeries. Patients with suspected bleeding colonic varices need immediate assessment, resuscitation, and hemodynamic stabilization. There are no evidence based guidelines for treatment for bleeding colonic varices, but options include medical, endoscopic, interventional radiological and surgical modalities.Figure 1.: Bear claw clip was used to achieve hemostasis.