An Uncommon Case of Small Bowel and Pancolonic Varices

Abstract

A 41-year-old patient with no known medical history presented to clinic for evaluation of iron-deficiency anemia. The patient underwent esophagogastroduodenoscopy and colonoscopy. Esophagogastroduodenoscopy was normal with no esophageal varices or other evidence of portal hypertension. Colonoscopy revealed diffuse colonic varices extending from the cecum to the rectum (Figure 1). Computed tomography enterography showed numerous varices of the midjejunum (Figure 2). Abdominal magnetic resonance imaging showed patent portal circulation and no other abnormalities. Transthoracic echocardiogram showed no evidence of right heart failure. Transjugular liver biopsy was performed which revealed a portosytemic pressure gradient of 4 mm of Hg, indicating the absence of portal hypertension. Liver biopsy showed mild steatosis and no fibrosis. Direct measurement of portal pressure was 3 mm Hg, again indicating the absence of portal hypertension. Both the superior mesenteric vein and inferior mesenteric vein were widely patent on mesenteric angiography, with no evidence of thrombosis. In the absence of hemodynamic evidence of portal hypertension or of any portal venous obstruction, the patient was diagnosed with idiopathic small bowel and colonic varices.

A Unique Presentation of Familial Idiopathic Colonic Varices

“… 7 While there have been individual cases with intestinal varices and normal portal pressures, adult familial case series are uncommon. 8 , 9 We present a mother-daughter case of idiopathic ileocolonic varices with normal portal pressure gradients.…”

Diffuse Idiopathic Colonic Varices: Demonstration Using Multiplanar Reconstructions from Triphasic Computed Tomography

“… 2 They usually present with lower gastrointestinal hemorrhage of varied severity or occult bleeding with chronic anemia. 3 , 4 The presence of colonic varices and possible etiologies of varices such as portal hypertension can easily be detected or ruled out on triphasic CT scans, specifically using reconstruction techniques. The detection of colonic angiodysplasia on CT angiography is a key differential diagnosis of the disease, particularly in the elderly population.…”