Colon Varices: A Rare Cause of Lower Gastrointestinal Bleeding

Varices of the colon are extremely rare, there having been but 7 cases reported thus far in the world literature. The purpose of this article is to record the eighth such case and to alert the radiologist to consider this condition as a possible cause of lower gastrointestinal bleeding. R. H., an 11-year-old white male, was first seen at the University of Illinois Research and Educational Hospitals in March 1955 because of rectal bleeding. He had been in good health until the age of two, when blood was first noted in the stool. Proctoscopy at that time demonstrated marked congestion of the rectal mucosa, but no treatment was advised. Because of continued bleeding, the boy was again subjected to proctoscopy at the age of five; on the basis of this examination, the diagnosis of “ulcerative colitis” was made. At the age of ten the bleeding became more severe, and proctoscopy showed an intensely inflamed mucosa with large veins submucosally. The spleen was also noted to be enlarged, and a diagnosis of “atypical ulcerative colitis with hypersplenism” was entertained. In October 1954, a splenectomy was performed. At this time the surgeon noted large dilated veins in the lower part of the rectosigmoid. The rectal bleeding stopped for about three months but then recurred. Proctoscopy now revealed numerous dilated submucosal veins. In February 1955 laparotomy was performed. Dilated vessels were seen covering the entire rectosigmoid colon, particularly near the bladder, and extending into the posterior abdominal wall. Venous pressure readings in the sigmoid and cecal regions exceeded 500 cm of water. No definitive procedure was undertaken. In March 1955 the patient underwent a third laparotomy, for the first time at the University of Illinois Hospitals. Huge veins were again noted; a fibrous cord lying next to the hepatic artery was considered to be the remnant of the portal vein. A homologous artery graft was placed between a varix of the rectosigmoid and the inferior vena cava. During this admission, esophageal varices were demonstrated on the upper gastrointestinal series. Because of continued rectal bleeding, another celiotomy was performed in June 1955; at this time the superior hemorrhoidal and a branch of the superior mesenteric veins were anastomosed to the inferior vena cava. Rectal bleeding persisted, and in August 1958, during a further laparotomy, a vein suitable for a shunting procedure could not be found. In 1961 the first episode of hematemesis occurred. The patient was then relatively asymptomatic until July 1963 when hematemesis recurred. He was admitted to the University of Illinois Hospitals for the fifth time in October 1963. A barium-enema examination disclosed an irregular rectosigmoid region with a cobblestone appearance (Figs. 1, 2). Esophagography showed extensive varices.