Laparoscopic sigmoid colectomy for idiopathic sigmoid colonic varices: A rare case report and literature review: A video vignette

Abstract Introduction Colonic varices are a rare cause of lower gastrointestinal bleeding and are usually associated with portal hypertension secondary to liver cirrhosis or portal venous obstruction. Idiopathic colonic varices (ICV), occurring in the absence of portal hypertension, are extremely rare, with fewer than 30 cases reported in the literature. Recognition of this entity is important, as it may cause recurrent or massive lower gastrointestinal bleeding with significant morbidity. Case Presentation A 27‐yearold woman presented with two episodes of moderate hematochezia, following which she sought medical attention. Per rectal examination revealed Grade I internal hemorrhoids, which did not correlate with the bleeding episodes. Colonoscopy showed a cluster of large, grossly dilated veins in the proximal sigmoid colon, with otherwise normal bowel up to the terminal ileum and Grade I internal hemorrhoids at the anal verge. CT angiography demonstrated a large venous malformation in the proximal sigmoid colon draining into the inferior mesenteric vein, with normal liver and mesenteric vasculature. Due to the large size of the varices, endoscopic and interventional radiological treatment was not feasible. Laparoscopic sigmoidectomy was performed. Histopathological examination revealed a submucosal vascular anomaly consistent with varicosity. A diagnosis of idiopathic colonic varices was made. The postoperative period was uneventful. Conclusion Idiopathic colonic varices are a rare but important cause of lower gastrointestinal bleeding. Exclusion of portal hypertension is essential for diagnosis. Surgical resection of the affected segment provides definitive treatment with an excellent prognosis.