ABSTRACT
Portal hypertension can lead to development of new veins, called collateral vessels in the esophagus, stomach, abdominal wall, rectum and so on. In particular, collateral vessels located in other site than the gastroesophageal region are defined as ectopic varices. These varices are fragile and can rupture easily, resulting in a large amount of blood loss that may become serious and occasionally result in death. We experienced a case of massive rectal variceal bleeding after cross-clamping of the inferior vena cava and hepatic portal vein during the living donor liver transplantation in patients who had no history of rectal variceal bleeding. Our case suggests that acute intraoperative hemorrhage from an ectopic varix should be a consideration before liver transplantation.