Variceal Hemorrhage of Ascending Colon

Abstract

A 33-year-old woman with a history of systemic lupus erythematosus was admitted to the hospital with melena, hematochezia, and syncope. Upper endoscopy did not demonstrate any bleeding source. Colonoscopy revealed varices between mid and distal ascending colon and blood clots at colonic mucosa (Figure A). Therefore, variceal hemorrhage in ascending colon was suspected. To find a cause of ascending colonic varices, abdominal computed tomography (CT) angiography (Figures B and C) was performed. CT angiogram demonstrated development of collateral vessels at retroperitoneum (black arrow, Figures B and C), abdominal wall (white arrow, Figure B), and drainage of both renal veins to the mentioned collateral vessels (4 white lightning arrows, Figure C), but liver cirrhosis, portal vein obstruction, and splenomegaly were not found.