Rare case of successfully operated idiopathic colonic varicosity – ScienceOpen
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      Rare case of successfully operated idiopathic colonic varicosity

      case-report

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          Abstract

          Introduction

          Ectopic gastrointestinal varicosities are defined as dilated portosystemic collateral veins that may localize anywhere in the gastrointestinal tract outside the gastroesophageal region. Ectopic colonic varices can be considered idiopathic when other etiology that related to portal hypertension or portal vein thrombosis have been excluded.

          Case presentation

          A forty-five-year-old female patient has been under treatment for histopathologically confirmed ulcerative colitis since the age of 17. In her forties, the patient developed worsening hematochezia leading to severe anemia. Routine colonoscopy was performed which confirmed extensive rectosigmoid varices. A thorough investigation did not confirm any underlying causes, such as portal hypertension or cirrhosis.

          Discussion

          The selective percutaneous transhepatic mesenteric angiography, which is recommended as a diagnostic and therapeutic option, was not performed because the interventional radiologists did not consider embolization feasible. Laparoscopic rectosigmoid resection with high ligation of the inferior mesenteric vein led to complete remission of hematochezia. The final histological examination confirmed ectopic rectum and sigmoid varices, and ulcerative colitis was ruled out.

          Conclusions

          Lower gastrointestinal bleeding from the colonic varices is very rare, with only a few cases reported in the literature. In the idiopathic form, the prognosis is very good, given the absence of other underlying diseases causing portal hypertension. Ectopic varices present a clinical challenge as they are difficult to diagnose and localize. There are currently no clear guidelines for diagnosis and therapy, and recommendations are based on different case reports. Idiopathic cases can be treated effectively by resection of the affected bowel segment.

          Highlights

          • The prognosis for the idiopathic ectopic varices is very good

          • Currently there are no clear guidelines for the diagnosis and treatment

          • In case where endoscopic and interventional radiological procerdures are not succesful surgical solution should be chosen

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          Most cited references23

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          Management of ectopic varices.

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            Ectopic varices: anatomical classification, hemodynamic classification, and hemodynamic-based management.

            Ectopic varices are dilated splanchnic (mesoportal) veins/varicosities and/or are dilated portosystemic collaterals that can occur along the entire gastrointestinal tract outside the common pathologic variceal sites. Ectopic varices are complex and highly variable entities that are not fully understood. Ectopic varices represent 2%-5% of a gastrointestinal tract variceal bleeding. However, ectopic varices have a 4-fold increased risk of bleeding when compared with esophageal varices and can have a mortality rate as high as 40%. All treatment strategies and techniques have been utilized in managing these potentially mortal varices and have shown poor outcomes. The debate of whether to manage these varices by decompression with a transjugular portosystemic shunt, or other portosystemic shunts, vs transvenous obliteration is unresolved. The rebleed rates after transjugular portosystemic shunt decompression are 20%-40%. The rebleed rates after transvenous obliteration and the mortality rate at 3-6 months are 30%-40% and 50%-60%, respectively. Hemodynamically from an etiology standpoint, there are 2 types: occlusive (type-b) and nonocclusive (oncotic or type-a). Hemodynamically from a vascular-shunting standpoint, there could be a component of portoportal or portosystemic shunting or both with varying dominance. This is the basis of the new classification system described herein. Management strategies (decompression vs sclerosis) are discussed. The ideal management strategy is a treatment that leads to prompt hemostasis but also addresses the etiology or hemodynamics of the ectopic varices. It is the hope that with better understanding, description, and categorization of ectopic varices comes a more systematic approach to this rare but menacing problem.
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              Clinicopathological Features and Treatment of Ectopic Varices with Portal Hypertension

              Bleeding from ectopic varices, which is rare in patients with portal hypertension, is generally massive and life-threatening. Forty-three patients were hospitalized in our ward for gastrointestinal bleeding from ectopic varices. The frequency of ectopic varices was 43/1218 (3.5%) among portal hypertensive patients in our ward. The locations of the ectopic varices were rectal in thirty-two, duodenal in three, intestinal in two, vesical in three, stomal in one, and colonic in two patients. Endoscopic or interventional radiologic treatment was performed successfully for ectopic varices. Hemorrhage from ectopic varices should be kept in mind in patients with portal hypertension presenting with lower gastrointestinal bleeding.
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                Author and article information

                Contributors
                Journal
                Int J Surg Case Rep
                Int J Surg Case Rep
                International Journal of Surgery Case Reports
                Elsevier
                2210-2612
                22 August 2024
                October 2024
                22 August 2024
                : 123
                : 110196
                Affiliations
                [a ]Department of Surgery, Faculty of General Medicine, University of Debrecen, Debrecen, Móricz Zsigmond körút 22, Hungary
                [b ]Prestige Private Hospital, Lujza u. 16, Nyíregyháza 4405, Hungary
                Author notes
                [* ]Corresponding author at: Department of Surgery, University of Debrecen, Medical and Health Science Centre, Móricz Zs. Krt. 22, Debrecen 4032, Hungary. kodergergely@ 123456gmail.com
                Article
                S2210-2612(24)00977-5 110196
                10.1016/j.ijscr.2024.110196
                11388158
                39181031
                a0af2b32-a8a7-41e9-b286-e01400ca48f1
                © 2024 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 11 June 2024
                : 15 August 2024
                : 17 August 2024
                Categories
                Case Report

                idiopathic varicosity,gastrointestinal bleeding,laparoscopy,case report

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