Fatal hemorrhage from rectal varices

Waxman, Jenny S.; Tarkin, Neil; Dave, Pradyuman B.; Waxman, Marian

doi:10.1007/bf02554608

Cited by 39 publications

(17 citation statements)

References 5 publications

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“…Hemorrhoidectomy should not be performed in the patient that may have rectal varices because of the risk of severe bleeding. Life-threatening bleeding, although rare, has been reported [84]. Rectal varices occur much more commonly in patients with portal hypertension (especially those that have undergone sclerotherapy of esophageal varices), but hemorrhoids occur no more commonly in cirrhotics than in age-matched controls [77].…”

Section: Colorectal Varicesmentioning

confidence: 99%

Extraesophageal Varices

Kotfila¹,

Trudeau²

1998

Dig Dis

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Esophageal varices are the most common site of variceal bleeding. However, bleeding from varices that are not located in the esophagus may account for up to 30% of all variceal bleeding. Significant varices can occur in the stomach, duodenum, jejunum, ileum, colon, rectum, and biliary tree. They can also occur at the site of a surgical ostomy. These types of varices bleed less commonly than esophageal varices, but they can also be far more difficult to diagnose and treat. The absence of stigmata of recent esophageal variceal bleeding and certain clues in the patient’s history and clinical presentation should raise the clinician’s suspicion of an extraesophageal site of variceal bleeding. Particularly, patients with extrahepatic causes of portal hypertension, cirrhotic patients with a prior history of gastrointestinal surgery, and patients who present with profound bleeding but without hematemesis need to be evaluated further if an obvious site of esophageal variceal bleeding is not seen on initial endoscopy. In this article, we review the features particular to extraesophageal varices as well as the diagnosis and management of bleeding from these varices. We use the term extraesophageal rather than ectopic because the term ectopic varices implies exclusion of both esophageal and gastric varices.

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Section: Colorectal Varicesmentioning

confidence: 99%

Extraesophageal Varices

Kotfila¹,

Trudeau²

1998

Dig Dis

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“…Bleeding anorectal varices are a less frequent complication than gastroesophageal variceal hemorrhage [7], but it may be massive and life-threatening [5, 8]. In our patient with cirrhosis and portal hypertension, the diagnosis of anorectal varices was evident in the presence of dilated bluish vessels protruding into the rectal lumen, and vascular feeding of the varices by a large inferior mesenteric vein with hepatofugal flow.…”

Section: Discussionmentioning

confidence: 90%

The Long-Term Efficacy of the Intrahepatic Portosystemic Shunt (TIPS) for the Treatment of Bleeding Anorectal Varices in Cirrhosis

Ory¹,

Megevand

Becker

et al. 2001

Digestion

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Background: In patients with portal hypertension and variceal hemorrhage, the transjugular intrahepatic portosystemic shunt (TIPS) is indicated when drug therapy or endoscopic treatment fails to control bleeding. Ruptured esophageal or gastric varices are the most frequent causes of portal hypertension-related hemorrhage, but anorectal varices may also bleed. Although several case reports have proposed TIPS in this situation, the long-term results of this procedure have not been described. Methods: We report here the case of a 68-year-old patient with decompensated cirrhosis who presented with recurrent hematochezia due to anorectal varices. Results: A successful control of bleeding could be obtained after placement of TIPS. After 3 years of follow-up, rectal bleeding did not recur, the shunt remained primarily patent, and the patient did not present overt hepatic encephalopathy. Conclusion: TIPS procedure should be considered as an effective treatment of recurrent bleeding from anorectal varices in patients with decompensated cirrhosis.

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“…The risk of bleeding varies from 1 to 8%, although there are a few reports of massive bleeding and even fatality from rupture of these varices [171,179]. The common site of occurrence includes the rectum and cecum [175].…”

Section: Colonic and Anorectal Varicesmentioning

confidence: 99%

“…Interestingly, the microscopic defect appears to be generalized and showed no correlation with the endoscopic findings [169]. Biopsy of the colonic mucosa from the site of colopathy as well as from normal looking mucosa showed dilated tortuous mucosal capillaries with irregular wall-thickening, edema of lamina propria and mild chronic inflammatory infiltrate [170,171] (Fig. 15).…”

Section: Portal Hypertensive Colopathymentioning

confidence: 99%

Avoiding Pitfalls: What an Endoscopist Should Know in Liver Transplantation—Part 1

2007

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Cirrhosis is associated with global homodynamic changes, but the majority of the complications are usually manifested through the gastrointestinal tract. Therefore, Gastrointestinal Endoscopy has become an important tool in the multidisciplinary approach in the management of these patients. With the ever growing number of cirrhotic patients requiring pre-transplant endoscopic management, it is imperative that the community endoscopists are well aware of the pathologies that can be potentially noted on Gastrointestinal Endoscopy. Their timely management is also considered to have the utmost importance in being able to stabilize the patient until their transfer to a Liver Transplant Center. The aim of this manuscript is to give a comprehensive update and review of various endoscopic findings that a non-transplant endoscopist will encounter in the pre-transplant setting.

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Fatal hemorrhage from rectal varices

Cited by 39 publications

References 5 publications

Extraesophageal Varices

Extraesophageal Varices

The Long-Term Efficacy of the Intrahepatic Portosystemic Shunt (TIPS) for the Treatment of Bleeding Anorectal Varices in Cirrhosis

Avoiding Pitfalls: What an Endoscopist Should Know in Liver Transplantation—Part 1

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