Endoscopic band ligation for transverse colonic variceal bleeding: case report and review of the literature

Abstract

Colonic varices are lesser-known in comparison with gastroesophageal varices in a complication associated with liver cirrhosis. The ideal therapeutic intervention for a colonic varix is still unclear. We report a 42 year-old man with 20 years of alcohol use who presented with hematochezia and abdominal distension. The patient was diagnosed with alcoholic liver cirrhosis. The colonoscopy revealed a dilated and tortuous varix in the transverse colon close to the hepatic flexure with oozing blood, a communicating branch and with "red sign", evidence of acute bleeding. Endoscopic band ligation (EBL), the most useful intervention for esophageal varices, was further successfully performed to arrest the bleeding colonic varices. One month after initial treatment, the colonic varices nearly vanished and were replaced by an ulcer. It is extremely rare for colonic varices to be treated with EBL. There is only one similar case in reported literature, but it seems to be safe and effective as an intervention for EBL for acute colonic variceal bleeding. SIMILAR CASES: Second case treated by endoscopic band ligation.

Figure 1.

Colonoscopy showed a dilated and tortuous varix in the transverse colon close to the hepatic flexure with massive red color sign, a communicating branch and bloody scab (arrow).

Figure 2.

All five rings were deployed to ligate the transverse colon varices (arrow).

Figure 3.

One month after endoscopic treatment, the transverse colon varices had nearly disappeared (arrow) and were replaced with a mild ulcer.