Pan-colonic varices and idiopathic portal hypertension

Varices of the lower GI tract, although rare, are a known cause of hematochezia. They are usually found in a segmental distribution and are often associated with cirrhosis, portal hypertension, or portal vein obstruction. We present the case of a 43-year-old male with no personal or family history of liver disease, who experienced recurrent rectal bleeding over a 27-year period. Colonoscopy revealed varices from the rectum to the cecum confirmed with endoscopic ultrasound, while esogastroduodenoscopy, small bowel series, and CT were all normal. Portal hypertension was present without an identifiable cause.