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• W2912449594 abstract "INTRODUCTION: Acute lower GI bleed etiology include diverticular bleed, ateriovenous malformation, hemorrhoid bleed, malignancy, colitis (ischemic, infectious or inflammatory). However, the differential becomes very limited and more interesting in younger and healthy patients. CASE DESCRIPTION: The patient presented to the ER with BRBPR. Rectal exam was unremarkable, anoscopy was performed demonstrating internal hemorrhoids. Patient was discharged home for outpatient follow-up. He comes back 12 hours later with significant hematochezia and lightheadedness. He was noted to be tachycardic with a HR of 123 and hypotensive with a BP of 93/54. His hemoglobin dropped from 13.5 to 7.2 within 12 hours. There is no family history of colon cancer or inflammatory bowel disease. After IV resuscitation, urgent EGD and colonoscopy were planned. EGD was unremarkable but the colonoscopy noted an abnormally dilated and tortuous blood vessel extending from the cecum to the mid ascending colon. An open ulceration was noted in the distal portion of the dilated vessel likely the site of the bleeding. Two hemoclips were placed at the site with good hemostasis. CT angiogram of the abdomen revealed numerous collateral vessels in the right lower quadrant, including varices within the ascending colon. MRI angiogram demonstrated small bowel drainage through the tortuous cecal varices before returning to the center superior mesenteric vein. The peripheral part of the superior mesenteric vein was atretic. There was no evidence of liver or pancreatic diseases. IR embolization was planned however, the bleeding has subsided with the endoscopic intervention. Patient was discharged in stable condition, he will have an outpatient follow-up with general surgery to consider a hemicolectomy. CASE DISCUSSION There are very few reported cases of idiopathic colonic varices in the literature. They are usually found incidentally at colonoscopy or discovered following a GI bleed. They are called idiopathic once portal hypertension, liver disease and pancreatic conditions are ruled out. Certain hypotheses were proposed to explain those varices: an inherited vascular anomaly, familial aggregation or venous malformations. There is limited data in the literature on this condition. It occurs more frequently in males and is diagnosed at the age of 40. There is no consensus for definitive treatment. Our patient will consider surgical intervention however a watchful waiting approach is also reasonable.FigureFigureFigure" @default.
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• W2912449594 date "2017-10-01" @default.
• W2912449594 modified "2023-09-27" @default.
• W2912449594 title "Case of Massive Lower GI Bleed in an 18-year-old With History of Constipation" @default.
• W2912449594 doi "https://doi.org/10.14309/00000434-201710001-01959" @default.
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