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

Abstract

Rare co-existance of disease or pathology Background:Colonic varices are rare entity that often results from portal vein hypertension and hepatic cirrhosis. In the absence of underlying pathology, they are termed "idiopathic colonic varices". They are usually an incidental finding; however, they can present with varying degrees of lower gastrointestinal bleeding. There is only one reported case in the literature of colonic varices with a concomitant colonic tumor; our patient is the second one with such a presentation. We report a case of this rare combination with the outcomes of the elected surgical management and review the literature. Case Report:A 24-year-old male was referred to our hospital with a 1-month history of colicky abdominal pain. His family history is remarkable of 2 relatives with colonic varices. A computed tomography scan of the abdomen and pelvis showed a hepatic flexure colonic mass. Colonoscopy revealed pancolonic varices. Biopsy from the lesion revealed adenocarcinoma. Options were discussed with the patient to undergo only a right hemicolectomy for his cancer or a total colectomy to include the colonic segment involved with varices, and he elected the first option, with no complications upon 1 year follow up. Conclusions:Idiopathic pan-colonic varices are rare pathology. Their presence with colonic tumor presents a dilemma as to whether a subtotal/total colectomy is needed on the premise that a limited resection may carry the risk of subsequent bleeding. In the literature, the only similar case to ours had brisk postoperative bleeding, while ours did not experience such a complication.

Lower Gastrointestinal Bleeding Associated With Variceal Hemorrhoidal Disease in a Patient With Pan-Colonic Varices

“…Most patients with colonic varices are asymptomatic, but the main clinical feature is gastrointestinal bleeding, ranging from mild microscopic bleeding with chronic anemia to life-threatening massive hemorrhage [5,[7][8][9].…”

“…However, fewer than 50 cases have been reported with an idiopathic presentation of pan-colonic involvement [ 1 , 2 ], with even lower prevalence rates. Males are more commonly affected, with a ratio of 25:15, and the average age of presentation is 41 years, ranging from 14 to 81 years [ 5 , 7 ].…”

“…However, in cases of idiopathic presentation, approximately 50% involve the entire colon. A familial form of the disease is diagnosed when multiple family members are affected [ 7 ]. In 2014, Speicher et al published a study where out of 39 cases of colonic varices found in the literature, 26 had pan-colonic involvement, and 15 had a familial component [ 5 ].…”

Treatment of colonic varices with a superior mesenteric venous stent: a case report describing a unique approach

“…They are usually located in the distribution of the inferior mesenteric vein (IMV) (66%), SMV distribution (26%), and mixed supply areas [ 5 ]. CV are most commonly diagnosed in cirrhotic patients with portal hypertension [ 6 ]. Non-cirrhotic etiologies include congestive heart failure, portomesenteric venous compromise, splenic venous thrombosis, inherited vascular anomalies, or they can be idiopathic [ 7 ].…”

Colonic Varices Revealed by Chronic Abdominal Pain: A Case Report

“…CV are most commonly diagnosed in cirrhotic patients with portal hypertension [6]. Non-cirrhotic etiologies include congestive heart failure, portomesenteric venous compromise, splenic venous thrombosis, inherited vascular abnomalities, or they can be idiopathic [7].…”