ECTOPIC VARICES, A RARE CAUSE OF GASTROIN TESTINAL-BLEEDING

From January 1986 to September 1995, 4 patients were hospitalized in o ur ward for gastrointestinal bleeding from ectopic varices. These pati ents were all female, aged 30 to 65 years. The etiology of portal hype rtension in these patients was alcoholic cirrhosis [2], cirrhosis in W ilson's disease [1] and previous alveolar echinococcosis treated by ri ght hepatectomy, complicated by post-operative portal thrombosis. Clin ical presentation in all 4 cases was lower gastrointestinal bleeding. Diagnosis was by emergency arteriography in 3 cases; no source was fou nd in one case with recurrent hemorrhage. The 4 patients had a history of abdominal surgery. The location of the ectopic varices was small b owel [2] and cecum [2]. 3 patients were treated surgically: right cole ctomy [1], partial small bowel resection [1] and porto-caval shunt wit h complete lysis of adhesions, One patient was treated conservatively with emergency placement of a TIPS (transjugular intrahepatic porto-sy stemic shunt), with simultaneous embolization of cecal varices. Upon l aparotomy all 3 surgical cases presented ectopic varices in post-opera tive adhesions. In conclusion, in a patient with portal hypertension p resenting with lower gastrointestinal bleeding, hemorrhage from ectopi c varices should be kept in mind and investigated by arteriography. A history of abdominal surgery seems to be a predisposing factor in deve lopment of ectopic varices by adhesion formation.