Intermittent bleeding from anorectal varices

A patient with anorectal varices is reported. Anorectal varices are a rare cause of rectal bleeding and are often erroneously diagnosed as bleeding hemorrhoids. However, the subcutaneous extension of the varices should alert the clinician. Although local treatment such as ligation of the varices has been advocated, in the presence of portal hypertension a more radical operation is recommended. A portosystemic shunt, preferably between the inferior mesenteric vein and the vena cava or renal vein, is then the treatment of choice.