Albeit rare, colonic varices are usually seen in the anorectum in the setting of portal hypertension, although idiopathic and familial cases of colonic varices have also been described. Cases have also been reported resulting from mesenteric hypertension secondary to portal or mesenteric vein (MV) thrombosis. The association of inflammatory bowel disease and MV thrombosis is well recognized. We are aware of only one case series describing Crohn's disease resulting in MV stenosis and subsequent portal hypertensive lower gastrointestinal varices. The series described 3 patients with small bowel (SB) varices. We report a case of superior MV stenosis resulting in colonic varices in a patient with Crohn's disease. The patient is a 43 year old male with Crohn's ileitis and proctitis, who had been in remission on oral mesalamine since the diagnosis 2 years prior. The patient presented with several weeks of intractable nausea and vomiting, intermittent melenic stools, and a reported 25 pound weight loss over 2 months. Physical examination was unrevealing and bloodwork was only remarkable for mild anemia. A CT-scan showed thickened distal SB, with possible narrowing of the superior MV with colonic collaterals. A SB follow-through was normal. The patient was started on antibiotics and immunosuppressive medications, with mild improvement. Upper endoscopy was unremarkable. Colonoscopy revealed erythematous mucosa and pseudopolyps in the distal ileum with an intrinsic stricture. Varices were seen in the ascending and transverse colon. An opening was seen at the rectosigmoid junction with passage of air and stool, which was consistent with an entero-colonic fistula when injected with contrast dye. The patient underwent angiogram with balloon angioplasty of the stenosed superior MV and ileocolic veins, which resulted in decomperssion of the varices. Surgical resection of the ileo-sigmoid fistula and multiple SB strictures was then performed. Pathology review revealed SB adenocarcinoma arising from the ileal aspect of the fistula, with positive lymph nodes. Severe intestinal inflammation from Crohn's Disease can result in stenosis in the adjacent vasculature. This is the first reported case of a patient with Crohn's disease and superior MV stenosis resulting in colonic varices.