Idiopathic ileo-colonic varices in a young patient

Abstract

Colonic varices are an infrequent cause of rectal bleeding and haematochezia and they are often related to portal hypertension due to either haepatopathy or any other cause of obstruction of the portal circulation. A 20-year-old patient was studied after she suffered a serious episode of rectal bleeding, followed by syncope. In view of her clinical picture of serious rectal bleeding, which could not be kept under control by means of medical therapy or endoscopy, the patient underwent total video laparoscopic colectomy surgery with ileum-rectum anastomosis. The histological examination revealed prominent ectasia presence of venous vessels under the mucosa. Colonic varices are one of the most common causes of low gastroenteric bleeding and in most cases they are caused by portal hypertension or intestinal occlusion. In less common cases, they are caused by thrombosis of the splenic vein, cardiac insufficiency, venous mesenteric thrombosis, extrinsic compression on tumoral invasion. Idiopathic colonic varices are described in the literature as the cause of low gastroenteric bleeding in not more than 20 patients. Therapeutic options are conservative follow-up or surgery. As it happened in our case, surgery is generally the chosen treatment, in view of the risk of recurring bleeding, the young age of patients and the low degree of co-morbidity of patients. The prognosis for surgery of idiopathic colonic varices is very good at any age when compared with the one for the treatment of varices caused by cirrhosis of the liver, thus confirming the importance of diagnosing idiopathic varices, only after having ruled out the presence of other basic pathologies.