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Recurrent lower gastrointestinal bleeding from idiopathic ileocolonic varices: a case report.

Krishna RP, Singh RK, Ghoshal UC - J Med Case Rep (2010)

Bottom Line: Varices of the colon are a rare cause of lower gastrointestinal bleeding, usually associated with portal hypertension due to liver cirrhosis or other causes of portal venous obstruction.We report the case of a 21-year-old Asian man from north India who presented with recurrent episodes of lower gastrointestinal bleeding.Thorough evaluation was undertaken to rule out any underlying portal hypertension.

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Affiliation: Department of Surgical Gastroenterology, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow 226014, India. rajneeshkumarsingh@hotmail.com.

ABSTRACT

Introduction: Varices of the colon are a rare cause of lower gastrointestinal bleeding, usually associated with portal hypertension due to liver cirrhosis or other causes of portal venous obstruction. Idiopathic colonic varices are extremely rare. Recognition of this condition is important as idiopathic colonic varices may be a cause of recurrent lower gastrointestinal bleeding.

Case presentation: We report the case of a 21-year-old Asian man from north India who presented with recurrent episodes of lower gastrointestinal bleeding. Colonoscopy revealed varices involving the terminal ileum and colon to the sigmoid. Thorough evaluation was undertaken to rule out any underlying portal hypertension. Our patient underwent subtotal colectomy including resection of involved terminal ileum and an ileorectal anastomosis.

Conclusion: Colonic varices are an uncommon cause of lower gastrointestinal bleeding. Idiopathic colonic varices are diagnosed after excluding underlying liver disease and portal hypertension. Recognition of this condition is important as prognosis is good in the absence of liver disease and is curable by resection of the involved bowel.

No MeSH data available.


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Capsule endoscopy shows dilated tortuous veins in terminal ileum.
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Figure 2: Capsule endoscopy shows dilated tortuous veins in terminal ileum.

Mentions: A 21-year-old Asian man from north India presented with history of recurrent episodes of lower gastrointestinal bleeding over the past six years. He had intermittent episodes, one to two per year, of passing bloody maroonish stools with occasional hematochezia. Episodes were self limited lasting two to three days, but required repeated hospital admissions with multiple blood transfusions. He had no significant past medical or family history of similar complaints. Physical examination was unremarkable. He was admitted with a fresh episode of lower gastrointestinal bleeding, which subsided spontaneously. Coagulation profile, liver function tests and hepatitis serology were normal. Upper gastrointestinal endoscopy to the third part of the duodenum did not reveal findings suggestive of portal hypertension or any other bleeding source. Colonoscopy revealed several large dilated tortuous sub-mucosal varices extending from the upper rectum, sigmoid, the entire colon extending into the terminal ileum (Figure 1). Our patient was examined for portal hypertension. Doppler ultrasound revealed normal liver size and echotexture, portal vein 10 mm, splenic vein 7 mm with normal hepatopetal flow and no evidence of collaterals. Magnetic resonance portovenogram revealed no evidence of cirrhosis or portal hypertension. Selective mesenteric angiography was carried out to search for any other vascular lesions in the gastrointestinal tract. All vascular territories were found to be normal and colonic lesions were undetected on an angiogram. Small bowel evaluation with enteroclysis was normal. However, capsule enteroscopy revealed evidence of tortuous dilated vessels in distal ileum (Figure 2).


Recurrent lower gastrointestinal bleeding from idiopathic ileocolonic varices: a case report.

Krishna RP, Singh RK, Ghoshal UC - J Med Case Rep (2010)

Capsule endoscopy shows dilated tortuous veins in terminal ileum.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2927604&req=5

Figure 2: Capsule endoscopy shows dilated tortuous veins in terminal ileum.
Mentions: A 21-year-old Asian man from north India presented with history of recurrent episodes of lower gastrointestinal bleeding over the past six years. He had intermittent episodes, one to two per year, of passing bloody maroonish stools with occasional hematochezia. Episodes were self limited lasting two to three days, but required repeated hospital admissions with multiple blood transfusions. He had no significant past medical or family history of similar complaints. Physical examination was unremarkable. He was admitted with a fresh episode of lower gastrointestinal bleeding, which subsided spontaneously. Coagulation profile, liver function tests and hepatitis serology were normal. Upper gastrointestinal endoscopy to the third part of the duodenum did not reveal findings suggestive of portal hypertension or any other bleeding source. Colonoscopy revealed several large dilated tortuous sub-mucosal varices extending from the upper rectum, sigmoid, the entire colon extending into the terminal ileum (Figure 1). Our patient was examined for portal hypertension. Doppler ultrasound revealed normal liver size and echotexture, portal vein 10 mm, splenic vein 7 mm with normal hepatopetal flow and no evidence of collaterals. Magnetic resonance portovenogram revealed no evidence of cirrhosis or portal hypertension. Selective mesenteric angiography was carried out to search for any other vascular lesions in the gastrointestinal tract. All vascular territories were found to be normal and colonic lesions were undetected on an angiogram. Small bowel evaluation with enteroclysis was normal. However, capsule enteroscopy revealed evidence of tortuous dilated vessels in distal ileum (Figure 2).

Bottom Line: Varices of the colon are a rare cause of lower gastrointestinal bleeding, usually associated with portal hypertension due to liver cirrhosis or other causes of portal venous obstruction.We report the case of a 21-year-old Asian man from north India who presented with recurrent episodes of lower gastrointestinal bleeding.Thorough evaluation was undertaken to rule out any underlying portal hypertension.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgical Gastroenterology, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow 226014, India. rajneeshkumarsingh@hotmail.com.

ABSTRACT

Introduction: Varices of the colon are a rare cause of lower gastrointestinal bleeding, usually associated with portal hypertension due to liver cirrhosis or other causes of portal venous obstruction. Idiopathic colonic varices are extremely rare. Recognition of this condition is important as idiopathic colonic varices may be a cause of recurrent lower gastrointestinal bleeding.

Case presentation: We report the case of a 21-year-old Asian man from north India who presented with recurrent episodes of lower gastrointestinal bleeding. Colonoscopy revealed varices involving the terminal ileum and colon to the sigmoid. Thorough evaluation was undertaken to rule out any underlying portal hypertension. Our patient underwent subtotal colectomy including resection of involved terminal ileum and an ileorectal anastomosis.

Conclusion: Colonic varices are an uncommon cause of lower gastrointestinal bleeding. Idiopathic colonic varices are diagnosed after excluding underlying liver disease and portal hypertension. Recognition of this condition is important as prognosis is good in the absence of liver disease and is curable by resection of the involved bowel.

No MeSH data available.


Related in: MedlinePlus