Laparoscopic colectomy in idiopathic colonic varices: a safe endeavour

Abstract

A 32-year-old man presented to the emergency department with recurrent episodes of haematochezia and haemodynamic instability. He had no complaints of alteration in bowel habits or mucus discharge in the stool. He was a non-smoker and does not consume alcohol. After stabilising the patient, clinical evaluation and investigations with gastrointestinal endoscopy revealed dilated and tortuous submucosal veins involving the entire colon excepting the distal sigmoid. CT angiography and Doppler ultrasonography revealed normal patency and flow in the mesenteric vessels as well as hepatic, portal vein and inferior vena cava. With the exclusion of the secondary causes, we made the diagnosis of the rare entity of idiopathic colonic varices. He underwent a laparoscopic colectomy with ileorectal anastomosis, without any additional technical challenges intra-op and had an uneventful postoperative recovery. Idiopathic colonic varices can be a differential diagnosis of gastrointestinal bleeding and one can safely proceed with laparoscopic colectomy.

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

“…Nonoperative treatment should be considered with surveillance, iron supplements, laxatives, and blood transfusions in patients with single bleeding episodes without hemodynamic instability [ 7 , 11 ]. Definitive treatment should involve resection of the affected colon segment with partial or total colectomy in cases of recurrence or patients with hemodynamic instability [ 7 , 9 , 12 ]. The prognosis of idiopathic varices seems to be better at all ages than cirrhotic varices; this may be related to low pressure in the varices as the absence of chronic hepatic disease.…”

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

“…It is a sporadic disease, and approximately 50 cases have been reported till date. 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.…”