AIM: To investigate the incidence and causes of ectopic varices (EV) in the gastrointestinal tract and to analyze the relationship between EV and portal hypertension (PH).

METHODS: The clinical data for 37 patients with EV in the gastrointestinal tract were retrospectively analyzed. Of these patients, 26 were diagnosed by endoscopic examination, 10 during transjugular intrahepatic portosystemic stent shunt (TIPSS) procedures, and one by percutaneous transhepatic inferior mesenteric venography. The diagnosis of PH was based upon the finding of portal vein dilatation in patients with hepatic cirrhosis (HC) and extrahepatic portal vein obstruction (EPVO) in patients without cirrhosis. Portal pressure was measured directly in patients who underwent TIPSS.

RESULTS: Patients with EV in the gastrointestinal tract were infrequently seen, representing 0.09% (26/28 967) of all patients undergoing endoscopic examination. Of all 37 cases of EV in the gastrointestinal tract, 6 occurred in the duodenum, 11 in the small intestine, 4 in the colon, and 16 in the anorectal region. In patients undergoing TIPSS, portal pressure ranged between 3.18 and 6.13 kPa, with a mean value of 4.07 kPa ± 0.92 kPa. The etiology of PH was HC in 26 cases and EPVO in 4 cases. In the remaining 7 cases, a specific cause had not been determined.

CONCLUSION: EV in the gastrointestinal tract is a rare condition, occurring most commonly in the duodenum, colon, and anorectal region. PH is the primary cause of EV, often resulting from HC and EPVO. Both EV and PH may be easily overlooked, and EV may occur in patients lacking the classic signs of PH.

• Ectopic varices
• Gastrointestinal tract
• Portal hypertension
• Endoscope
• Transjugular intrahepatic portosystemic stent shunt

Since the original description of colonic varices in 1954 [N Engl J Med 1954;250:434-438], fewer than 100 cases have been reported in the literature. Particularly, even fewer cases of cecal varices have been reported. More than 75% of these cases have been due to portal hypertension. Our objective is to contribute a rare case with an uncommon presentation to the medical literature. We present the case of a 53-year-old male with hepatitis C and hepatitis B liver cirrhosis who presented for outpatient colonoscopy. The indication for colonoscopy was bright red blood per rectum and iron deficiency anemia. A significant amount of varices were noted in the cecum and proximal ascending colon. No endoscopic evidence of colonic bleeding was noted. This is the first reported case of cecal varices not presenting with massive lower gastrointestinal bleeding.

• Cecum
• Colon
• Liver
• Portal hypertension
• Varices

• Arteriovenous malformation
• Ileocecal varix
• Portal hypertension

Colonic varices are a very rare cause of lower gastrointestinal bleeding. Fewer than 100 cases of colonic varices, and 30 cases of idiopathic colonic varices (ICV) have been reported in the English literature. Among these 30 cases of ICV, 19 cases were diagnosed by angiography, and 7 operated cases were diagnosed later as ileocecal vein deficit, hemangioma, and idiopathic in 1, 1, 5 cases, respectively. We report the case of a 24-year-old man who suffered from multiple episodes of hematochezia of varying degree at the age of 11 years. He had severe anemia with hemoglobin of 21 g/L. On colonoscopy, tortuously dilated submucosal vein and friable ulceration covered with dark necrotic tissues especially at the rectosigmoid region were seen from the rectum up to the distal descending colon. It initially appeared to be carcinoma with varices. Mesenteric angiographic study suggested a colonic hemangioma. Low anterior resection was done due to medically intractable and recurrent hematochezia. Other bowel and mesenteric vascular structures appeared normal. Microscopic examination revealed normal colonic mucosa with dilated veins throughout the submucosa and serosa without representing new vessel growth. Taken all of these findings together, the patient was diagnosed as ICV. His postoperative course was uneventful.

• Idiopathic colonic varices
• Hematochezia
• Colon cancer
• Hemangioma

• Adult
• Colon/blood supply
• Colonic Neoplasms/diagnosis
• Diagnostic Errors
• Gastrointestinal Hemorrhage/etiology
• Humans
• Male
• Varicose Veins/complications
• Varicose Veins/diagnosis

• Adolescent
• Colectomy
• Colon/blood supply
• Colonoscopy
• Gastrointestinal Hemorrhage/etiology
• Humans
• Male
• Varicose Veins/complications
• Varicose Veins/diagnosis
• Varicose Veins/surgery

• Chronic Disease
• Combined Modality Therapy
• Esophageal and Gastric Varices/diagnosis
• Esophageal and Gastric Varices/etiology
• Esophageal and Gastric Varices/therapy
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Humans
• Liver Diseases/complications
• Liver Diseases/therapy
• Prognosis

• MO1-RR008658 NCRR NIH HHS
• NIDDK 41301 NIDDK NIH HHS
• NIDDK R01-33273 NIDDK NIH HHS