An unusual differential diagnosis of a left iliac fossa mass

Abstract

We present a case of decompensated alcoholic liver cirrhosis with widespread porto-systemic anastamoses that resulted in varices within the rectus muscle. A literature review reveals only two similar cases previously. Intramuscular varices may predispose to local haemorrhage, especially in those with underlying coagulopathy as a result of liver cirrhosis. Management options include optimising medical management of the underlying condition, simple analgesics, and for those at high risk of bleeding, decompression by transjugular intrahepatic porto-systemic shunting. Interim monitoring by ultrasonography is also helpful in detecting rapid increases in vascular size. In our case the patient continued to drink heavily and developed hepatic encephalopathy. Her prognosis remains poor and is currently a poor candidate for any surgical intervention.