Isolated non-hemorrhagic cecal varices

Abstract

Ectopic varices (those outside of the gastro-esophageal region) are occasionally found on endoscopy in patients with portal hypertension; however they account for a small minority of all variceal bleeds. Cases of isolated cecal varices are quite rare and, when described, often present with acute hemorrhage or evidence of occult bleeding. We present the case of a 29-year-old male with a history of idiopathic portal vein thrombosis and known esophageal varices, who presented for evaluation of abdominal pain. Cecal varices were found on endoscopy, without evidence of bleeding and without varices in the remainder of the colon or rectum. Endoscopic ultrasound and computed tomography were useful in confirming the diagnosis and natural history of these unusual varices.

Massive Cecal Variceal Hemorrhage Treated with Transjugular Intrahepatic Portosystemic Shunt with Right Colic Vein and Ileocolic Vein Embolization

“…Cecal varices are exceedingly rare and have not been well described in the literature [1]. Moreover, cecal varices are usually found in the context of pan-colonic varices, unlike the case described herein [5]. Cecal varices most often develop secondary to portal hypertension, usually in the context of alcohol-induced liver cirrhosis [2].…”

“…Unfortunately, in the setting of hemorrhage the diagnostic rate of colonoscopy is reduced and patients with bleeding cecal varices are likely to be in a critical condition, making colonoscopy potentially prohibitive [11]. Other treatment options range from resuscitation and observation to total colectomy depending on patient and institutional factors [5]. A recent, multicenter, retrospective study attempted to assess the efficacy of TIPS procedure for patients for ectopic variceal bleeding; however, only one patient from their sample suffered from bleeding cecal varices [3].…”

Idiopathic Isolated Colonic Varices: An Extremely Rare Condition

“…A variety of modalities can be used to diagnose colonic varices, some of which include routine and capsule endoscopy, barium enema, nuclear scintigraphy, CT and CT angiography, endoscopic ultrasound, and color Doppler-flow imaging (CDUS).Of these diagnostic options, CT angiography may exhibit the greatest potential because it locates varices in a manner that is both precise and minimally invasive [ 7 ]. Selective mesenteric angiography also allows for therapeutic intervention at the time of diagnosis [ 8 ].…”

Balloon-occluded retrograde transvenous obliteration of colonic varices: a case report

“…Although there are established guidelines for the management of oesophageal and gastric variceal bleeding, this is currently lacking for colonic varices. Various treatment methods have been reported, including the use of beta-blockers, transjugular intrahepatic portosystemic shunt (TIPS), and subtotal colectomy (El-Masry and Hu 2010; Francois et al 2007;Haddad and Lacey 2014;Klein et al 2003;Mehta et al 2019;Mikat 1971;Shaper et al 1996;Krishna et al 2010;Langemets and Ilves 2017). However, management is typically dependent on local expertise, the underlying cause and the site of the varices.…”