Case of Bleeding Ileal Varices after a Colectomy Diagnosed by Capsule Endoscopy

Chang Joon Park; Bong Eun Lee; Hye Kyung Jeon; Gwang Ha Kim; Geun Am Song; Sang Hwa Ko; So Jeong Lee; Do Youn Park

doi:10.4166/kjg.2018.71.6.349

Journal List > Korean J Gastroenterol > v.71(6) > 1097312

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Park, Lee, Jeon, Kim, Song, Ko, Lee, and Park: Case of Bleeding Ileal Varices after a Colectomy Diagnosed by Capsule Endoscopy

Case Report

Korean J Gastroenterol 2018;71(6):349-353.

Published online: 4 October 2018

DOI: https://doi.org/10.4166/kjg.2018.71.6.349

Case of Bleeding Ileal Varices after a Colectomy Diagnosed by Capsule Endoscopy

Chang Joon Park, Bong Eun Lee, Hye Kyung Jeon, Gwang Ha Kim, Geun Am Song, Sang Hwa Ko¹, So Jeong Lee², Do Youn Park²

Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea

¹Department of Surgery, Pusan National University School of Medicine, Busan, Korea

²Department of Pathology, Pusan National University School of Medicine, Busan, Korea

Correspondence to: Bong Eun Lee, Department of Internal Medicine, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea. Tel: +82-51-240-7869, Fax: +82-51-244-8180, E-mail: bongsul@hanmail.net

Received 14 February 2018 Revised 21 March 2018 Accepted 28 March 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We report a case of bleeding ileal varices associated with intraabdominal adhesions after colectomy which was successfully diagnosed using capsule endoscopy. A 77-year-old woman visited the emergency department for several episodes of melena. She had a medical history of neoadjuvant chemoradiation therapy and subsequent surgery for rectal cancer 6 years previously. Conventional diagnostic examinations including upper endoscopy, colonoscopy, and abdominal computed tomography could not detect any bleeding focus, however, following capsule endoscopy revealed venous dilatations with some fresh blood in the distal ileum, indicating bleeding ileal varices. The patient underwent exploratory laparotomy and the affected ileum was successfully resected. No further gastrointestinal bleeding occurred during the 6 months follow-up. Small intestinal varices are important differential for obscure gastrointestinal bleeding especially in patients with a history of abdominal surgery in the absence of liver cirrhosis, and capsule endoscopy can be a good option for diagnosing small intestinal varices.

Keywords: Gastrointestinal hemorrhage, Capsule endoscopy

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Fig. 1.

Colonoscopy showed dark blood retention in the entire colon, originating from oral side of the ileocecal valve. (A) Transverse colon. (B) Ileocecal valce. (C) Terminal ileum.

Fig. 2.

Capsule endoscopy showed bluish venous dilation with bloody intestinal fluids in the distal ileum.

Fig. 3.

Abdominal computed tomography revealed venous dilatation on the ileum (red arrows) adjacent to the uterus.

Fig. 4.

Histopathology findings. (A, B) Gross findings of the resected ileum showed a well-defined tortuous, engorged vascular structure (red arrows) on the serosal (A) and mucosal (B) surface. (C, D) On a microscopic examination, submucosa (C, H&E, ×40) and subserosa (D, H&E, ×40) showed irregularly dilated venous structures (red arrows). (E) Fibrous bands (star) around the dilated tortuous varices were observed on the subserosa (H&E, ×40).

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