Varices rectales, una causa rara de hemorragia masiva en la hipertensión portal
Rectal varices, a rare cause of massive bleeding in portai hypertension
Las varices rectosigmoideas constituyen una manifestación de hipertensión portal extremadamente rara, pero pueden producir hematoquecias. Las varices rectales se forman por anastomosis submucosas entre venas rectales inferiores provenientes de la vena mesentérica inferior y las venas rectales medias e inferior, provenientes de la vena ilíaca.
Rectosigmoidal varices are a extremely uncommon manifestations of portal hypertension but can cause massive hematochezia. Rectal varices occur as submucosal anastomoses between the superior rectal veins of the inferior mesenteric system and the middle and inferior rectal veins of the iliac system. In portal hypertension there is an increased flow and pressure through these anastomotic channels. Rectal varices are so rare beause in most people the rich coronary azygos system is better developed and thus shunts more blood. Because of congenital or anatomic variations, the rectal anastomosis are better developed in some people and will shunt more blood, causing rectal varices.
The clinical presentation varies from rectal loss of very small quantities of bright red blood to torrential life threatening bleeding. Proctosigmoidoscopy is the preferential diagnostic tool in the absence of bleeding. Selective arteriography is the safest and most accurate diagnostic investigation in the presence of bleeding.
Therapy is controversial and varies from conservative « waiting »’ to colonic resection or portocaval shunting. More recently other therapeutic interventions as sclerotherapy and ligation of the rectal varices have been described. We report a patient with alcoholic liver cirrhosis who developed massive lower gastrointestinal bleeding due to rectosigmoidal varices. Diagnosis was made by selective arteriography and a colonic resection was performed.
K. DE KEYSER, D. MEIRE, M. DE VOS, A. ELEWAUT, F. BARBIER
cirrosis, higado, hemorragia, hipertensión portal, varices rectales