A case of variceal bleeding of the ascending colon associated with alcoholic liver cirrhosis / 대한내과학회지

ABSTRACT

We report a very rare case of colonic varix with massive bleeding. A 43-year-old male patient was transferred to our hospital for hematochezia. The patient had a history of chronic liver disease associated with alcohol use. The initial blood pressure was 93/73 mmHg, and the hemoglobin level was 8.4 g/dL. Severe hepatomegaly and periportal fatty infiltration were seen on abdominal computed tomography. Markedly ectatic veins protruded from the luminal side of the proximal ascending colon and drained to the dilated ileocecal and retroperitoneal veins. Emergent colonoscopy failed because of continuous hematochezia and hypovolemic shock, despite massive transfusion. Markedly dilated colonic varices were noticed around the ileocecal and ascending colon on superior mesenteric arteriography. An emergent right hemicolectomy was performed. The presumed bleeding focus was a protruding varix with a red clot on the top of a denuded vein on the anteromedial wall of the proximal ascending colon.