Diffuse idiopathic varices in the colon characterized by lower gastrointestinal bleeding

Abstract

Diffuse idiopathic varices in the colon characterized by lower gastrointestinal bleedingColon varices are very rare lesions that usually present as secondary to portal hypertension. Idiopathic colon varices are even rarer, and should be considered especially in the etiology of massive lower gastrointestinal bleeding. Forty-five year old male presented to our hospital with complaints of recurrent rectal bleeding for one week and severe anemia. The patient was transfused with 4 units of blood. His colonoscopy revealed diffuse submucosal varices. The tests performed for investigation of etiology did not reveal any portal pathology. The patient did not experience another episode of active bleeding during follow-up and was discharged with conservative recommendations. Idiopathic colon varices are rare but should be considered in the differential diagnosis of patients presenting with massive rectal bleeding. Conservative approach is first line of treatment, reserving segmental or total colectomy only for ongoing hemorrhage.

Idiopathic Ileocolonic Varices Coexisting with a Colon Polyp Treated Successfully by Endoscopy: A Case Report and Literature Review

“…A family tendency was evaluated in 16 cases, and 6 cases had familial tendency (9,20,25). Occurrence site of varices was mentioned in 23 cases, and 6 cases (26.1%) were ileocolonic varices (6,16,21,22,27,28) and 12 (52.2%) were total colonic varices (2,3,5,17,19,20,23,24,29,30). The entire colon was involved in almost 80% of cases.…”

“…To our knowledge, there have been 29 reports on 33 patients with idiopathic colonic varices published since 1986 (Table 2) (2-30). On reviewing these cases, the average age was 44.8 years old, and 17 (77.3%) of the 22 patients were men (4,6-10,12,13,18,19,21,23,24,27,29). A family tendency was evaluated in 16 cases, and 6 cases had familial tendency (9,20,25).…”

Familial Idiopathic Pan-Colonic Varices Found Incidentally in a Young Patient with a Hepatic Flexure Tumor

“…Most of the reported cases in the literature presented with LGIB ranging from recurrent minimal per rectal bleeding with anemia to massive and life threatening-bleeding [2,[9][10][11]. Bleeding in these cases may be precipitated by trauma caused by the passage of hard stool or by mucosal ulceration due to ischemia induced by varices enlargement [9,12].…”

“…However, they can be easily missed during insufflation or in a hypotensive state when their volume is reduced. Biopsy is not advised as this may result in heavy bleeding [5,12]. Colon capsule endoscopy was also used in some reports, especially in cases where the varices disappeared during colonoscopy.…”

“…However, initial management follows the same approach as with other cases of LGIB. Correction of the underlying cause in the non-idiopathic case is also needed [1][2][3][4][5][6][7][8][9][10][11][12]. As far as ICVs are concerned, many authors opted to reserve surgical management to those patients presenting with hemodynamically significant or recurrent and intractable bleeding, while conservative therapy, with observation, iron supplements, laxatives or periodic blood transfusion, is a preferred option in the less severe cases [4,6,[9][10][11][12][13][14].…”