Recurrent lower gastrointestinal bleeding from idiopathic ileocolonic varices: a case report

Abstract

Introduction: Varices of the colon are a rare cause of lower gastrointestinal bleeding, usually associated with portal hypertension due to liver cirrhosis or other causes of portal venous obstruction. Idiopathic colonic varices are extremely rare. Recognition of this condition is important as idiopathic colonic varices may be a cause of recurrent lower gastrointestinal bleeding.

Case presentation: We report the case of a 21-year-old Asian man from north India who presented with recurrent episodes of lower gastrointestinal bleeding. Colonoscopy revealed varices involving the terminal ileum and colon to the sigmoid. Thorough evaluation was undertaken to rule out any underlying portal hypertension. Our patient underwent subtotal colectomy including resection of involved terminal ileum and an ileorectal anastomosis.

Conclusion: Colonic varices are an uncommon cause of lower gastrointestinal bleeding. Idiopathic colonic varices are diagnosed after excluding underlying liver disease and portal hypertension. Recognition of this condition is important as prognosis is good in the absence of liver disease and is curable by resection of the involved bowel.

Figure 1

Colonoscopy shows dilated tortuous veins extending throughout the colon.

Figure 2

Capsule endoscopy shows dilated tortuous veins in terminal ileum.

Figure 3

(A) Terminal ileum shows evidence of tortuous dilated veins on surface (arrows) with clear demarcation from proximal small bowel. Colon normal except for few dilated veins over surface of sigmoid (arrowhead). (B) Cut specimen of colon shows prominent tortuous sub-mucosal vessels (arrows).