Colonic Varices

A 50-year-old man with alcohol-induced cirrhosis was hospitalized with lower GI bleeding. On examination, he was pale, heart rate was 100 beats per minute, and blood pressure was 100/60 mm Hg. He was anemic (hemoglobin level, 9 g/dL) and thrombocytopenic (platelet count, 112,000/µL).

Lucía C. Fry, MD, and Klaus E. Mönkemüller, MD, of Magdeburg, Germany, report that a colonoscopy revealed varices in the left colon, which are shown here. An esophagogastroduodenoscopy demonstrated grade 1 esophageal varices without bleeding.

Colonic varices are a rare cause of lower GI bleeding.¹ They can be part of the portal hypertension syndrome. Colonic varices have also been described in patients with previous abdominal surgery or tumor metastasis, which compresses the intra-abdominal vessels or leads to thrombosis of the mesenteric veins.¹

The treatment of colonic varices depends on the cause and the amount of bleeding. Some patients have only 1 episode of bleeding and require no further treatment. Patients with recurrent and sometimes massive bleeding may require portosystemic shunts or colonic resection. Endoscopic treatments include injection with cyanoacrylate, sclerotherapy, and argon plasma coagulation.² Medical therapy aimed at reducing portal pressure provides effective prophylaxis of bleeding from esophageal varices and may help prevent bleeding from colonic varices as well.

This patient was treated with intravenous octreotide for 3 days. Oral b-blockers were prescribed at discharge. During 1-year follow-up, the patient had no further GI bleeding. *