Varices of the Entire Colon - an Unusual Cause of Recurrent Intestinal Bleeding

Weingart, J; Höchter, W.; Ottenjann, R

doi:10.1055/s-2007-1021582

Cited by 30 publications

(16 citation statements)

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“…Less common causes of colonic varices are congestive heart failure, mesenteric vein thrombosis, pancreatitis with splenic vein thrombosis, adhesions and mesenteric vein compression. [56][57][58] Conventional EUS (7.5 or 12 MHz) reveals rectal varices as rounded, oval, or longitudinal echo-free structures in the submucosa and also shows perirectal veins outside the rectal wall. Sato et al demonstrated that intramural rectal varices, perirectal collateral veins, and the communicating veins between intramural rectal varices and perirectal collateral veins could be observed clearly via an ultrasonic microprobe.…”

Section: Applied Anatomy Of Colonic and Rectal Varicesmentioning

confidence: 99%

Collateral Pathways in Portal Hypertension

Sharma

Rameshbabu²

2012

Journal of Clinical and Experimental Hepatology

128

104

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Presence of portosystemic collateral veins (PSCV) is common in portal hypertension due to cirrhosis. Physiologically, normal portosystemic anastomoses exist which exhibit hepatofugal flow. With the development of portal hypertension, transmission of backpressure leads to increased flow in these patent normal portosystemic anastomoses. In extrahepatic portal vein obstruction collateral circulation develops in a hepatopetal direction and portoportal pathways are frequently found. The objective of this review is to illustrate the various PSCV and portoportal collateral vein pathways pertinent to portal hypertension in liver cirrhosis and EHPVO. ( J CLIN EXP HEPATOL 2012;2:338-352) A lmost any vein in the abdomen may serve as a potential collateral channel to the systemic circulation. Presence of abnormal collateral vessels appears to be one of the most sensitive (70-83%) and specific sonographic signs for the diagnosis of portal hypertension. 1 When blood flow through a vessel or a vascular bed is obstructed due to occlusion, as in EHPVO, or distortion, as in liver cirrhosis, collateral pathways open up as blood bypasses the occlusion or obstruction, always flowing down a pressure gradient from a high pressure to a low-pressure vessel or bed. The formation of portosystemic pathways occurs due to reopening of collapsed embryonic channels or reversal of the flow within existing adult veins. 2,3 The number of collateral channels depends on the severity of portal hypertension i.e. the differential gradient driving the flow between the portal and the systemic circulations and the duration of portal hypertension. The more severe and more prolonged the portal hypertension, the higher are the number of portosystemic pathways. However, this traditional hypothesis has been challenged and it has been suggested that the formation of portosystemic collateral circulation may be due in part to angiogenesis driven by vascular endothelial growth factor. 4,5 Almost 50 years have passed since the first detailed description of portosystemic collateral veins (PSCV) in portal hypertension appeared. 6 Precise mapping of PSCV is essential to therapeutic decisions and multidetector computerized tomography (MDCT) is sometimes used for cartography of PSCV. 7 EUS is increasingly being used for evaluation of PSCV and additionally provides an option for performing therapeutic interventions. 8 In addition to PSCV, PPCV pathways are frequently found in extrahepatic portal vein obstruction (EHPVO). The objective of this review is to illustrate the various PSCV and PPCV pathways pertinent to portal hypertension in liver cirrhosis and EHPVO. NORMAL PORTOSYSTEMIC ANASTOMOSESThe left gastric vein (LGV) anastomoses with the esophageal veins, which in turn drain into the azygos vein (AV). The superior rectal vein (SRV) anastomoses with the middle and inferior rectal veins (IRV), which are, respectively, tributaries of the internal iliac and the pudendal veins. The paraumbilical vein (PUV) anastomoses with subcutaneous veins in the anterior abdominal...

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Section: Applied Anatomy Of Colonic and Rectal Varicesmentioning

confidence: 99%

Collateral Pathways in Portal Hypertension

Sharma

Rameshbabu²

2012

Journal of Clinical and Experimental Hepatology

128

104

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“…4,5,7 Idiopathic varices of the colon are very rare as only 31 cases having been reported in the literature. [4][5][6][7][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Before concluding that they are true idiopathic colonic varices, we must exclude significant liver disease and portal venous obstruction. 7 In 19 of the reported cases, there is a familial aggregation of uncertain significance.…”

Section: Discussionmentioning

confidence: 99%

Massive Lower Gastrointestinal Bleeding From Idiopathic Ileocolonic Varix: Report of a Case

Lopes¹,

Ramada²,

Certo³

et al. 2006

Diseases of the Colon &Amp; Rectum

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“…In no reported case were varices caused by portal hypertension due to cirrhosis of the liver, which is otherwise the most common cause of intestinal varices. In a few patients varices of the transverse colon were part of varicosis involving the entire colon, presumably of congenital origin [7,8]. Varices in the vicinity of the splenic flexure of the bowel in I reported case were due to splenic vein thrombosis [10].…”

Section: Discussionmentioning

confidence: 99%

“…The varices in a few patients were due to vascular anomalies [6][7][8]. Feldman and co-workers suggested compromise of mesenteric vein circulation as a third cause of colonic varices [2].…”

mentioning

confidence: 99%