Laparoscopic colectomy in idiopathic colonic varices: a safe endeavour

A 32-year-old man presented to the emergency department with recurrent episodes of haematochezia and haemodynamic instability. He had no complaints of alteration in bowel habits or mucus discharge in the stool. He was a non-smoker and does not consume alcohol. After stabilising the patient, clinical evaluation and investigations with gastrointestinal endoscopy revealed dilated and tortuous submucosal veins involving the entire colon excepting the distal sigmoid. CT angiography and Doppler ultrasonography revealed normal patency and flow in the mesenteric vessels as well as hepatic, portal vein and inferior vena cava. With the exclusion of the secondary causes, we made the diagnosis of the rare entity of idiopathic colonic varices. He underwent a laparoscopic colectomy with ileorectal anastomosis, without any additional technical challenges intra-op and had an uneventful postoperative recovery. Idiopathic colonic varices can be a differential diagnosis of gastrointestinal bleeding and one can safely proceed with laparoscopic colectomy.