A case of idiopathic colonic varices: a rare cause of hematochezia misconceived as tumor

Abstract

Colonic varices are a very rare cause of lower gastrointestinal bleeding. Fewer than 100 cases of colonic varices, and 30 cases of idiopathic colonic varices (ICV) have been reported in the English literature. Among these 30 cases of ICV, 19 cases were diagnosed by angiography, and 7 operated cases were diagnosed later as ileocecal vein deficit, hemangioma, and idiopathic in 1, 1, 5 cases, respectively. We report the case of a 24-year-old man who suffered from multiple episodes of hematochezia of varying degree at the age of 11 years. He had severe anemia with hemoglobin of 21 g/L. On colonoscopy, tortuously dilated submucosal vein and friable ulceration covered with dark necrotic tissues especially at the rectosigmoid region were seen from the rectum up to the distal descending colon. It initially appeared to be carcinoma with varices. Mesenteric angiographic study suggested a colonic hemangioma. Low anterior resection was done due to medically intractable and recurrent hematochezia. Other bowel and mesenteric vascular structures appeared normal. Microscopic examination revealed normal colonic mucosa with dilated veins throughout the submucosa and serosa without representing new vessel growth. Taken all of these findings together, the patient was diagnosed as ICV. His postoperative course was uneventful.

Figure 1

Colonoscopy view of colonic varices at the rectosigmoid region.

Figure 2

Abdomen-pelvis triphasic computed tomography showing an arterial phase image of mucosal enhacement (A) venous (B) and delayed(C) phase images of delayed diffuse wall enhancement.

Figure 3

Trans-rectal Doppler sonography of colonic varices.

Figure 4

Selective angiography of superior and inferior mesenteric artery showing normal arterial phase (A) and venous pooling in rectum in the delayed phase (B).

Figure 5

Dilated subserosal veins seen in operation (A), great enlarged vessels observed in submucosal and serosal layer at low power, HE×10 (B), and distortion of vascular wall found in enlarged vessels at high power, HE×40 (C).