Abdul Ahad Ehsan Sheikh, MD1, Mahesh Cheryala, MD1, Vishwadhipa Voore, MD1, Sreekanth Avula, MD1, Dean R. Adams, MD2 1Wright Center for GME, Scranton, PA; 2Commonwealth Health Wilkes-Barre General Hospital, Plains, PA
Introduction: Colonic varices are a rare finding usually associated with portal vein hypertension and hepatic cirrhosis. In the absence of any known underlying pathology, it can be termed idiopathic which is scarcely reported in the literature. We present a unique case of incidental finding of idiopathic pan-colonic varices in an asymptomatic patient.
Case Description/Methods: A 49-year-old gentleman was taken for a screening colonoscopy based on his age. Past medical and surgical history consisted of hypertension, gastroesophageal reflux disease, and cholecystectomy. The patient was asymptomatic and had no reported history of gastrointestinal bleed or anemia. Physical exam within normal limits. A comprehensive metabolic panel two weeks before the procedure showed all indices within normal limits. Upon intubation of the scope and throughout the colon, the patient was noted to have very dilated intestinal varices measuring up to 8 mm in diameter. They were serpiginous and extending throughout the colon. Milder varices were also noted in the terminal ileum. There was no evidence of bleeding.
Discussion: Colonic varices is an extremely rare entity with less than 100 reported cases of both idiopathic and non-idiopathic cases combined. It has an incidence of about 0.0007% based on an autopsy study . Besides portal vein hypertension, it can also be seen with chronic pancreatitis, congestive heart failure, distant malignancies, postoperative mesenteric adhesions, and mesenteric or splenic vein obstruction. Idiopathic colonic varices can be familial although the mode of inheritance is not yet understood. It commonly presents with painless hematochezia but can be an incidental finding as in our case. Diagnosis is usually with colonoscopy however there lies a possibility of misdiagnosis due to collapse of varices after the inflation.
As witnessed in our case, pan-colonic varices are more commonly seen in idiopathic cases versus the cases secondary to portal hypertension, which can help distinguish between the two entities. Depending on the severity of symptoms it can be managed conservatively with observation and blood transfusion or definitively with surgery. However, due to the under-reported nature of the disease, definitive management recommendations are lacking for both idiopathic and non-idiopathic colonic varices. Further studies are needed to define the etiology and management of idiopathic intestinal varices.
Feldman MSr et al. Varices of the colon: report of three cases. JAMA 1962;179:729—30.
Figure: Colonoscopy showing non-bleeding varices throughout the colon.
Disclosures: Abdul Ahad Ehsan Sheikh indicated no relevant financial relationships. Mahesh Cheryala indicated no relevant financial relationships. Vishwadhipa Voore indicated no relevant financial relationships. Sreekanth Avula indicated no relevant financial relationships. Dean Adams indicated no relevant financial relationships.
Abdul Ahad Ehsan Sheikh, MD1, Mahesh Cheryala, MD1, Vishwadhipa Voore, MD1, Sreekanth Avula, MD1, Dean R. Adams, MD2. P0200 - A Rare Case of Idiopathic Pan-Colonic Varices in an Asymptomatic Patient, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.