S3462 Colonic Varices as a Cause for Lower GI Bleeding

Abstract

INTRODUCTION: Varices are defined as abnormally dilated tortuous vessels, which can be prone to bleeding and hemorrhaging. Varices found in the colon are rare, and can be due to portal hypertension or can be considered idiopathic if there are no identifiable etiologies. Colonic varices due to portal hypertension will typically follow a classic distribution in the cecum and rectum. We present a case of a patient with known decompensated cirrhosis and portal hypertension found to have gastrointestinal bleeding from left-sided colonic varices, believed to be idiopathic given his variceal distribution spread farther than the cecum. CASE DESCRIPTION/METHODS: The patient is a 60 year old male with past medical history significant for decompensated liver cirrhosis secondary to hepatitis C virus with ascites and portal systemic encephalopathy who was sent to the emergency department after a recent stress test showed atrial fibrillation with rapid ventricular response in the setting of worsening anemia. He endorsed having chronic intermittent melena and hematochezia. His hemoglobin was found to be 7.6 g/dL, with his baseline hemoglobin known to be around 9 g/dL. His telemetry showed continued atrial fibrillation, ranging from 100-140 beats per minute. The patient’s main complaint was acute on chronic fatigue, but denied chest pain, shortness of breath, or dizziness. He was started on an intravenous proton pump inhibitor, an octreotide drip, and ceftriaxone for spontaneous bacterial peritonitis prophylaxis. The patient underwent an upper and lower endoscopy that was notable for grade II esophageal varices, portal hypertensive gastropathy, submucosal nodule in the duodenum, a tubulovillous adenoma at the ileocecal valve, and left-sided colonic varices. Bleeding resolved and the patient was discharged home. DISCUSSION: Colonic varices are a rare cause for lower gastrointestinal bleeding. More so, varices located beyond the cecum and rectum are exceedingly rare and can less often be attributed to portal hypertension. While our patient demonstrated decompensated liver cirrhosis, his colonic varices extended farther than would be typically expected. While the etiology of our patient’s varices cannot be distinguished, management is the same, primarily focused on monitoring, and sclerotherapy, band ligation, or surgical resection if bleeding remains uncontrolled.Figure 1.: Colonic varices.