Portal Hypertensive Colopathy: a rare case of gastrointestinal bleeding and pelvic pain

Inferior vena cava (IVC) atresia is a type of IVC anomaly and accounts for up to 5% of unprovoked DVTs in young patients aged 20–40 years. IVC atresia can be congenital or acquired.We report the case of a 35-year old female patient with rectal bleeding and pelvic pain.Colonoscopy revealed edematous and erythematous mucosa from the anal verge to the distal sigmoid colon. Initial biopsies from the rectum reveald chronic nonspecific proctitis. The differential diagnosis included new-onset inflammatory bowel disease (IBD).A 5-ASA was started but without clinical improvement.Control rectoscopy and control biopsies were performed.The pathohistological analysis confirm that mucosal architecture was preserved. In the lamina propria, there was an extremely marked proliferation of slightly dilated capillaries akin to those encountered in portal hypertensive colopathy. A magnetic resonance angiography (MRA) reveald inferior vena cava agenesis (IVCA), infrarenal segment. It is evident that the patient has an anomaly of the inferior vena cava that is not monitored below the inflow of the renal veins, and there are also no common iliac veins. Pelvic pain may be associated with dilated periovarial and periuterine veins (venous congestion) part of the anomaly described. This should be distinguished from pelvic congestion syndrome in the context of gonadal vein insufficiency and retrograde blood flow and the consequent dilation of periovarial veins. Due to rectal bleeding, argon plasma coagulation and synthetic haemostatic material were applied on changed mucosa of sigmoid colon and rectum.Further clinical monitoring of the patient, symptomatic treatment is indicated,anticoagulant therapy due to the absence of DVT is questionable as a preventive measure [1] [2] [3].

Publication History

Article published online:
27 March 2025

• References

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