P1055 - An Uncommon Case of Small Bowel and Pan-Colonic Varices

Presenting Author(s)

• 

  Vick DiCarlo, II, MD

  Internal Medicine Resident
  UAB
  Hoover, Alabama

Vick S. DiCarlo, II, MD¹, Sujan Ravi, MD², Mohamed Shoreibah, MD², Patrick Kamath, MD³

¹University of Alabama at Birmingham School of Medicine, Birmingham, AL; ²University of Alabama at Birmingham, Birmingham, AL; ³Mayo Clinic, Rochester, MN

Introduction: We present a case of idiopathic varices in the small bowel and colon discovered after extensive work up for iron-deficiency anemia and portal hypertension.

Case Description/Methods:
41-year-old with no known medical history underwent esophagogastroduodenoscopy (EGD) and colonoscopy for evaluation of iron-deficiency anemia. EGD was normal. Colonoscopy revealed diffuse colonic varices extending from the cecum to the rectum (figure 1). Computed tomography enterography showed numerous varices of the mid jejunum. Magnetic resonance imaging of the abdomen showed patent portal circulation and no other abnormalities. Echocardiogram did not show any evidence of right heart failure. Transjugular liver biopsy showed a portosytemic pressure gradient of  4 mm of Hg indicating the absence of portal hypertension. Liver biopsy only showed mild steatosis and no fibrosis. A direct measurement of portal pressure was 3mmof Hg  again indicating the absence of portal hypertension. 

Discussion: Given the extensive workup with no evidence of portal hypertension, patient is thought have idiopathic varices in the small bowel and colon. Ectopic varices, especially in the colon are rare and are usually associated with portal hypertension. Idiopathic colonic varices in association with small bowel varices are even more infrequently described in existing literature. Clinical presentation has been reported with massive hemorrhage, recurrent bleeds and even as incidental findings in endoscopies and imaging performed for other reasons. Management options include conservative frequent follow up or surgery if there is evidence of recurrent bleeds or massive hemorrhage.

Disclosures:

Citation: Vick S. DiCarlo, II, MD; Sujan Ravi, MD; Mohamed Shoreibah, MD; Patrick Kamath, MD. P1055 - AN UNCOMMON CASE OF SMALL BOWEL AND PAN-COLONIC VARICES. Program No. P1055. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.