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].
