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      Familial Idiopathic Pan-Colonic Varices Found Incidentally in a Young Patient with a Hepatic Flexure Tumor

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          Abstract

          Patient: Male, 24-year-old

          Final Diagnosis: Colon cancer

          Symptoms: —

          Medication: —

          Clinical Procedure: Laparoscopic right hemi-colectomy

          Specialty: Surgery

          Objective:

          Rare co-existance of disease or pathology

          Background:

          Colonic varices are rare entity that often results from portal vein hypertension and hepatic cirrhosis. In the absence of underlying pathology, they are termed “idiopathic colonic varices”. They are usually an incidental finding; however, they can present with varying degrees of lower gastrointestinal bleeding. There is only one reported case in the literature of colonic varices with a concomitant colonic tumor; our patient is the second one with such a presentation. We report a case of this rare combination with the outcomes of the elected surgical management and review the literature.

          Case Report:

          A 24-year-old male was referred to our hospital with a 1-month history of colicky abdominal pain. His family history is remarkable of 2 relatives with colonic varices. A computed tomography scan of the abdomen and pelvis showed a hepatic flexure colonic mass. Colonoscopy revealed pancolonic varices. Biopsy from the lesion revealed adenocarcinoma. Options were discussed with the patient to undergo only a right hemicolectomy for his cancer or a total colectomy to include the colonic segment involved with varices, and he elected the first option, with no complications upon 1 year follow up.

          Conclusions:

          Idiopathic pan-colonic varices are rare pathology. Their presence with colonic tumor presents a dilemma as to whether a subtotal/total colectomy is needed on the premise that a limited resection may carry the risk of subsequent bleeding. In the literature, the only similar case to ours had brisk postoperative bleeding, while ours did not experience such a complication.

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          Most cited references41

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          • Article: not found

          Diagnosis and management of ectopic varices

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            Familial and idiopathic colonic varices: an unusual cause of lower gastrointestinal haemorrhage.

            A patient is described presenting with an acute lower gastrointestinal haemorrhage as a result of extensive colonic varices. Further investigation revealed that there were no oesophageal varices or splenomegaly. Liver biopsy showed grade II fatty change only, with no other specific or significant pathological features. Transhepatic portography showed a raised portal pressure (20 mm/Hg) but the portal system was patent throughout. There was an abnormal leash of vessels in the caecum thought to represent a variceal plexus. This patient was diagnosed as having idiopathic colonic varices. This case is discussed together with nine other reports of idiopathic colonic varices from the published literature. Four of these reports describe idiopathic colonic varices in more than one member of the same family. Possible modes of inheritance, aetiology of variceal change, natural history, and prognosis are discussed.
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              Pan-colonic varices and idiopathic portal hypertension.

              Varices of the lower GI tract, although rare, are a known cause of hematochezia. They are usually found in a segmental distribution and are often associated with cirrhosis, portal hypertension, or portal vein obstruction. We present the case of a 43-year-old male with no personal or family history of liver disease, who experienced recurrent rectal bleeding over a 27-year period. Colonoscopy revealed varices from the rectum to the cecum confirmed with endoscopic ultrasound, while esogastroduodenoscopy, small bowel series, and CT were all normal. Portal hypertension was present without an identifiable cause.
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                Author and article information

                Journal
                Am J Case Rep
                Am J Case Rep
                amjcaserep
                The American Journal of Case Reports
                International Scientific Literature, Inc.
                1941-5923
                2020
                07 March 2020
                : 21
                : e920934-1-e920934-10
                Affiliations
                [1 ]Department of General Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
                [2 ]Department of General Surgery, United Arabs Emirates University, Alain, Abu Dhabi, United Arab Emirates
                [3 ]Department of General Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
                Author notes
                Corresponding Author: Hadeel AlOmran, e-mail: Hadeelalomran92@ 123456gmail.com

                Authors’ Contribution:

                [A]

                Study Design

                [B]

                Data Collection

                [C]

                Statistical Analysis

                [D]

                Data Interpretation

                [E]

                Manuscript Preparation

                [F]

                Literature Search

                [G]

                Funds Collection

                Conflict of interest: None declared

                Article
                920934
                10.12659/AJCR.920934
                7081949
                32144234
                f3161a2b-4d8c-461a-87fe-fcecfbea9a72
                © Am J Case Rep, 2020

                This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International ( CC BY-NC-ND 4.0)

                History
                : 24 October 2019
                : 26 December 2019
                : 24 January 2020
                Categories
                Articles

                colon, ascending,colonic neoplasms,colorectal neoplasms

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