CASE REPORTS   

Chirurgia 2012 April;25(2):111-4

Copyright © 2012 EDIZIONI MINERVA MEDICA

language: English

A rare case of idiopathic colonic varices: case report and review of the literature

Grasso E. ¹, Sciolli L. ¹, Ravetta F. ², Pelloni A. ¹

¹ Unit of Surgery and Traumatology, La Carità Hospital, Locarno, Switzerland; ² Unit of Gastroenterology, La Carità Hospital, Locarno, Switzerland

Colonic varices, a very rare cause of lower gastrointestinal bleeding, are usually secondary to portal hypertension. It was reported that the incidence of colonic varices is 0.07%. There are no autopsy data about idiopathic colonic varices. This rare cause of lower gastrointestinal haemorrhage is almost invariably associated with liver cirrhosis and consequent portal hypertension or portal venous obstruction. A 33-year-old man was admitted to hospital with exertional dyspnea and weakness. He had a 3-year history of multiple episodes of hematochezia of varying degree. He denied alcohol consumption, or any family history of gastrointestinal bleeding. He had severe anemia with hemoglobin of 6.5 g/dL. Colonoscopy revealed considerable bluish and tortuously dilated submucosal veins which were seen from the rectum up to the distal descending and ascending colon. At surgery his liver was normal and there was no evidence of portal hypertension. Small bowel was normal except for the terminal 15 cm, which showed evidence of dilated tortuous subserosal vessels with a clear demarcation from rest of small bowel marked by a meandering dilated mesenteric vein, confirmed by intra-operative enteroscopy. Serosal aspect of colon was normal except few dilated veins descending and ascending colon. Sub-total colectomy including the terminal ileum was performed with an ileocolic anastomosis. The rectum was relatively spared of varices. The colectomy specimen revealed multiple dilated tortuous sub-mucosal vessels in the colon. Colonic varices are a very rare cause of lower gastrointestinal bleeding. Portal hypertension is the most common cause of colonic varices, which are usually located in the rectosigmoid region and the cecum. In the suspected case, the physician should consider the clinical, radiologic, and surgical informationcollectively for the proper diagnosis. ICV can be confirmed by surgical histopathogy, and successfully treated with partial colectomy on involved area.