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Management of Bleeding due to Idiopathic Colonic Varices
Abhimati Ravikulan1,2, Richard Gearry1,2,3,4,5, Jan Kubovy1,2
1Department of Gastroenterology, Christchurch Hospital, Christchurch, New Zealand.
ACG Case Reports Journal
|August 4, 2025
Summary
Idiopathic colonic varices (ICV) causing lower gastrointestinal bleeding are rare. This case highlights successful endoscopic treatment and carvedilol prophylaxis for ICV in a patient without liver disease.
Area of Science:
- Gastroenterology
- Vascular Medicine
Background:
- Idiopathic colonic varices (ICV) are an uncommon cause of lower gastrointestinal bleeding.
- Etiology and standardized management protocols for ICV remain poorly defined.
Observation:
- A 66-year-old male presented with recurrent hematochezia.
- Colonoscopy revealed extensive colonic varices.
- No evidence of liver disease or portal hypertension was found.
Findings:
- The patient's condition was successfully managed with immediate endoscopic intervention.
- Secondary prophylaxis was initiated using carvedilol, a nonselective beta-blocker.
- This approach proved effective despite the unknown pathophysiology of ICV.
Implications:
- This case suggests that endoscopic treatment combined with beta-blocker prophylaxis may be a viable strategy for managing ICV.
- Further research is warranted to establish definitive treatment guidelines for this rare condition.
- Physicians should consider ICV in patients with unexplained lower GI bleeding, even without risk factors for portal hypertension.
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