Extensive Idiopathic Colonic Varices in a Young Patient

Keren, Dean; Rainis, Tova; Stermer, E; Goldstein, Omer; Lavy, Alexandra

doi:10.1007/s10620-005-2729-z

Cited by 5 publications

(3 citation statements)

References 12 publications

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“…Due to the idiopathic nature of the disease and the associated blood loss, at least 13 cases required at least a partial resection of the bowel. [1][2][3][4][5][6][7][8][9][10][11][12][13] However, conservative management was deemed prudent in most cases. 12,[14][15][16][17][18][19][20][21][22][23][24][25][26][27] Most colonic varices of known origin were found along either the distribution of the superior or inferior mesenteric vein, but idiopathic varices tended to occur throughout the colon.…”

Section: Resultsmentioning

confidence: 99%

“…varices that involved the entire colon. [1][2][3][4][5][6]10,[12][13][14][15][16][17][18][19][21][22][23][25][26][27][28][29][30] There have been several cases of colonic varices without portal hypertension in which an alternate etiologic process was identified. Three instances of vascular malformations leading to colonic varices, [35][36][37] with 2 including a hereditary component, 35,36 have been documented.…”

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A Case of Idiopathic Colonic Varices

Speicher¹,

Keegan²,

Kirk³

2014

Journal of Osteopathic Medicine

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Colonic varices, usually detected by means of colonoscopy, are extremely rare and typically indicative of portal hypertension or chronic hepatopathology. Even more rare are those cases with no underlying disease, or idiopathic colonic varices. The authors report a case of these unexplained varices found during colonoscopy of a 30-year-old man with a 10-year history of diarrhea and occasional bloody stool. A thorough workup was performed, revealing no underlying abnormalities for his varices. Additionally, the authors review the literature of this rare diagnosis. Physicians must rule out hepatic, vascular, and cardiac causes before classifying a case of varices as idiopathic.

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Section: Resultsmentioning

confidence: 99%

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A Case of Idiopathic Colonic Varices

Speicher¹,

Keegan²,

Kirk³

2014

Journal of Osteopathic Medicine

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“…As part of conservative treatment, if the patient presents with anemia without requirement for transfusion or if anemia persists despite transfusion, iron supplements may be recommended. In patients with a history of constipation, the intestinal contents should be kept soft with recommendations of a dietician and oral laxatives (1,3,6). Our patient was started on oral iron preparations and lactulose treatment due to a hemoglobin level of 9.5 g/dL after 4 units of red blood cell transfusion and constipation.…”

Section: Discussionmentioning

confidence: 98%

Diffuse idiopathic varices in the colon characterized by lower gastrointestinal bleeding

Akküçük¹,

Aydogan²,

Paltaci³

et al. 2014

UCD

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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.

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Absent inferior mesenteric vein as a cause of lower gastrointestinal bleeding: The first reported case in the literature

Gibreel

Mansuri

Grothe

et al. 2014

Journal of Pediatric Surgery Case Reports

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a b s t r a c tTo date, absent inferior mesenteric vein (IMV) has not been reported in the literature as a cause of or being associated with lower gastrointestinal (GI) bleeding. We describe a case of 13 year-old girl who presented with hematochezia and was subsequently found to have widespread colonic varices involving the ascending, transverse and proximal descending colon. The upper GI tract, small bowel, and rectum were not involved. Delayed venous phase of mesenteric angiography revealed an absent inferior mesenteric vein. The patient underwent laparoscopic extended right hemicolectomy with ileosigmoid anastomosis. No bleeding from recurrent varices occurred during a 1-year period of follow up. We conclude that extended right hemicolectomy is a potential curative surgical option in patients presenting with lower GI bleeding from colonic varices caused by absent IMV. Upper GI and small intestinal involvement should be excluded to prevent future bleeding from missed varices these sites.Ó 2014 The Authors. Published by Elsevier Inc. All rights reserved. BackgroundLower gastrointestinal (GI) bleeding can be caused my many etiologies in pediatric patients, a fact that makes the diagnosis challenging in this age group. Colonic varices have been described as a causative etiology in many case reports [1e9], none of these reports described the congenital absence of inferior mesenteric vein (IMV) as an underlying cause of these varices. We describe the first case of lower GI bleeding associated with colonic varices secondary to a congenital absence of the inferior mesenteric vein. Case reportA 13 year-old female with no significant past medical history presented to her local emergency department with a five-day history of intermittent rectal bleeding, urgency, and tenesmus which was thought to be gastroenteritis on initial evaluation. She was admitted to our facility after she passed a loose bloody bowel movement followed by a syncopal attack. Her hemoglobin level was 5.9 g/dl (10 g/dl prior to admission). Her initial physical exam was remarkable for minimal left lower quadrant pain. Meckel's diverticulum scan was negative. Esophagogastroduodenoscopy excluded the Upper GI as a potential cause of her bleeding. Subsequent flexible sigmoidoscopy revealed thick, sticky, tenacious, melanotic stool throughout the rectum and sigmoid colon with some fresh blood under the melanotic stool. Computed tomography (CT) scan of the abdomen revealed moderate thickening and edema of the wall of the ascending colon with multiple small prominent vessels in the region of the hepatic flexure. Abdominal ultrasonography with Doppler study excluded portal venous flow obstruction and hypertension.Repeat colonoscopy after bowel preparation identified multiple varices in the ascending colon, hepatic flexure, transverse colon, and splenic flexure [Figs. 1e4], with stigmata of recent hemorrhage in ascending colon and hepatic flexure. The distal and proximal extent of the varices was endoscopically tattooed.In an attempt to identify the cause of co...

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Extensive Idiopathic Colonic Varices in a Young Patient

Cited by 5 publications

References 12 publications

A Case of Idiopathic Colonic Varices

A Case of Idiopathic Colonic Varices

Diffuse idiopathic varices in the colon characterized by lower gastrointestinal bleeding

Absent inferior mesenteric vein as a cause of lower gastrointestinal bleeding: The first reported case in the literature

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