PRIMARY VARICES OF THE COLON, A RARE CAUSE OF GASTROINTESTINAL-BLEEDING

History: A 34-year-old patient presented with a two-day history of pas sing bright-red blood with his stools. There was no contributory past or family history and he had no accompanying symptoms. Investigations: Colonoscopy revealed many varices in the colon and terminal ileum wit hout an active source of bleeding. Angiography failed to demonstrate a ny bleeding or vascular anomaly in the splanchnic region. Abdominal ul trasound and gastroscopy as well as biochemical tests did not indicate portal hypertension or liver cirrhosis. Treatment and course: On the night of admission there was a renewed fall in haemoglobin concentrati on. Emergency colonoscopy again failed to discover a source of bleedin g. After transfusion of four units of erythrocyte concentrate the furt her course was uneventful. 8 months and 3 years later there were furth er episodes of marked bleeding per rectum. At the latest admission no source for the bleeding was found but there was some blood oozing in t he sigmoid colon. Biochemical tests were unremarkable. The large varic es were again seen in the colon and terminal ileum. Gastroscopy, Doppl er sonography of the liver and repeat abdominal sonography again faile d to demonstrate portal vein thrombosis, liver cirrhosis or portal hyp ertension. Conclusion: In case of colonic varices the differential dia gnosis should include portal hypertension with chronic liver disease, portal vein thrombosis, vascular anomalies or postoperative complicati ons. The treatment of primary varices, which are rare, is conservative .