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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.

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

(A) Terminal ileum shows evidence of tortuous dilated veins on surface (arrows) with clear demarcation from proximal small bowel. Colon normal except for few dilated veins over surface of sigmoid (arrowhead). (B) Cut specimen of colon shows prominent tortuous sub-mucosal vessels (arrows).
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Figure 3: (A) Terminal ileum shows evidence of tortuous dilated veins on surface (arrows) with clear demarcation from proximal small bowel. Colon normal except for few dilated veins over surface of sigmoid (arrowhead). (B) Cut specimen of colon shows prominent tortuous sub-mucosal vessels (arrows).

Mentions: At surgery his liver was normal and there was no evidence of portal hypertension. Intra-operatively, portal pressure measured by cannulating mesenteric veins was normal. Small bowel was normal except for the terminal 15 cm, which showed evidence of dilated tortuous sub-serosal vessels with a clear demarcation from rest of small bowel marked by a meandering dilated mesenteric vein (Figure 3a), confirmed by intra-operative enteroscopy. Serosal aspect of colon was normal except few dilated veins at sigmoid (Figure 3a). There were no collaterals in the colonic mesentery or retroperitoneum. Sub-total colectomy including the terminal ileum was performed with an ileorectal anastomosis. The rectum was relatively spared of varices. The colectomy specimen revealed multiple dilated tortuous sub-mucosal vessels in the colon (Figure 3b). Histology revealed large dilated thin walled vascular channels in the submucosa.


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

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

(A) Terminal ileum shows evidence of tortuous dilated veins on surface (arrows) with clear demarcation from proximal small bowel. Colon normal except for few dilated veins over surface of sigmoid (arrowhead). (B) Cut specimen of colon shows prominent tortuous sub-mucosal vessels (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: (A) Terminal ileum shows evidence of tortuous dilated veins on surface (arrows) with clear demarcation from proximal small bowel. Colon normal except for few dilated veins over surface of sigmoid (arrowhead). (B) Cut specimen of colon shows prominent tortuous sub-mucosal vessels (arrows).
Mentions: At surgery his liver was normal and there was no evidence of portal hypertension. Intra-operatively, portal pressure measured by cannulating mesenteric veins was normal. Small bowel was normal except for the terminal 15 cm, which showed evidence of dilated tortuous sub-serosal vessels with a clear demarcation from rest of small bowel marked by a meandering dilated mesenteric vein (Figure 3a), confirmed by intra-operative enteroscopy. Serosal aspect of colon was normal except few dilated veins at sigmoid (Figure 3a). There were no collaterals in the colonic mesentery or retroperitoneum. Sub-total colectomy including the terminal ileum was performed with an ileorectal anastomosis. The rectum was relatively spared of varices. The colectomy specimen revealed multiple dilated tortuous sub-mucosal vessels in the colon (Figure 3b). Histology revealed large dilated thin walled vascular channels in the submucosa.

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